Departmental Endophthalmitis study: Increased risk associated with iodine allergy.

Abstract

Purpose : The causes of endophthalmitis are evolving, especially after increased ocular interventions including intravitreal injections and cataract operations. The purpose of this study was to report causes, clinical presentation, microbiologic spectrum and visual outcomes along with associated risk factors for suspected cases of endophthalmitis to help reduce the incidence in the future.

Methods : A retrospective case study on the suspected endophthlamitis cases was carried out. The patients were identified from the surgical register between the time period 1^st August 2014 to 30^th August 2016 over 25 months inclusive. The medical records were reviewed to evaluate clinical features, microbiology spectrum and treatment outcomes.

Results : 16 patients were identified. Clinical setting included post-cataract (n=3), post-intravitreal injections (n=6), post-vitrectomy (n=1), endogenous (n=2), long-term implant related (n=3) and bleb-related (n=1). All patients presented with reduced visual acuity and pain. 56% presented with hypopyon. All patients underwent an intravitreal tap and antibiotics per protocol and 63% underwent pars plana vitrectomy (n=10), of which two were diagnostic. Positive cultures were obtained in 37% (n=6 out of 16). Identified organisms were staphylococcus epidermidis (n=5) and pseudomonas aeriginosa (n=1). Most significant risk factor for patients presenting with suspected endophthalmitis after intravitreal injections was allergy to iodine -50% (n=3) of these cases the patient was allergic to iodine and therefore iodine was not used during the procedure. In six post intravitreal endophthalmitis cases the most common bacteria was staphylococcus epidermidis, found in 83% (n=5). One patient underwent evisceration.

Conclusions : Most common cause of suspected endophthalmitis was post intravitreal Aniti-VEGF injections. Most of these cases were caused by staphylococcus epidermidis, which is the normal flora of skin around the eyes. PPV was more likely to be used for post-intravitreal injection with proven staphylococcus epidermidis infection. One reason for the high incidence for endophthalmitis therefore could be iodine allergy as half of the post intravitreal cases were iodine allergic patients. Although the outcomes of visual acuity were fair, strict testing for allergy testing should be implemented to help reduce future incidences.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.