Abstract
Purpose :
Endophthalmitis is a dreaded complication of any ophthalmologic intervention. Our review is the largest study of endophthalmitis cases in the literature thus far. We seek to analyze the treatment approach and outcomes of endophthalmitis in post-operative cataract surgery patients.
Methods :
A retrospective database was created of all patients with a diagnosis of endophthalmitis from 1/2009 to 12/2017 in a large retina practice. A total of 552 eyes were identified, of which 207 were following cataract surgery. Visual acuity (VA) at presentation, final VA, time from surgery to presentation, and treatment strategy were collected. Visual outcomes were compared in those presenting within 3 days of surgery to those presenting after 3 days.
Results :
Of 207 patients, 130 were female and 77 were male. The average age was 71.3 years. The average presenting VA was 1.56 ± 0.92 logMAR. The average final VA was 0.47 ± 0.73 logMAR after a mean follow up of 12.5 months. Among all patients, 184 (88.8%) were treated with tap and injection, 11 (5.3%) were injected only, 9 (4.5%) underwent pars plana vitrectomy, and 2 received tap and injection followed by vitrectomy within 1 day. Of 207 eyes, 134 (64.7%) had a final VA of 20/40 or better and 29 (14%) had a VA of 20/200 or worse. The date of surgery was documented for 164 patients, allowing for analysis of the temporal relationship between surgery and endophthalmitis presentation. Among this group, patients presented an average of 9.01 days post-operatively. Sixty-six patients presented within 3 days of surgery and 98 presented after 3 days. Those within 3 days of surgery had a statistically significant difference in VA on presentation: 1.46 ± 0.90 versus 1.76 ± 0.84, p=0.03. There was no significant difference in final VA: 0.42 ±0.68 versus 0.57 ± 0.83, p=0.19. Of patients presenting within 3 days, 47 (71.2%) had a final VA of 20/40 or better and 7 (10.6%) had a final VA of 20/200 or worse. Among patients presenting after three days, 60 (61.2%) had a final VA of 20/40 or better and 20 (20.4%) had a final VA of 20/200 or worse.
Conclusions :
Endophthalmitis following cataract surgery is a rare, but critical complication. Although VA at presentation was better in patients presenting within 3 days, there was no significant difference in final VA regardless of time to presentation. However, there was a trend towards a larger percentage of patients with final VA of 20/200 or worse among those presenting after 3 days.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.