Abstract
Purpose :
To identify systemic comorbidities and ocular conditions that serve as predictors of using pars plana vitrectomy (PPV) for the management of open globe injury (OGI)-related endophthalmitis in different age groups: ages 0-21 (pediatric group (PG)), ages 22-64 (adult group (AG)), and ages 65+ (senior group (SG)).
Methods :
Using the 2008-2013 National Inpatient Sample Database, we performed a cross-sectional observational study of cases of endophthalmitis associated with open globe injury. Variables included in the regression model were: congestive heart failure, coagulopathy, diabetes with and without complications, drug abuse, hypertension, liver disease, lymphoma, fluid and electrolyte disorders, metastatic disease, neurological diseases, obesity, paralysis, psychoses, panophthalmitis, orbital cellulitis, keratitis, corneal ulceration, glaucoma, and presence of intraocular foreign body). Statistical analysis was performed using IBM SPSS Statistics 23 software. P-values of less than 0.05 were considered significant.
Results :
A total of 246 cases of OGI-associated endophthalmitis were identified. Of these cases, 63 (25.6%) were in PG, 127 (51.6%) in AG, and 56 (22.8%) in SG with average ages of 11.5 years (SD = 6.44), 43.5 (SD = 12.30), and 80.0 (SD = 8.77), respectively. Males comprised 72% of overall cases (76% PG, 82% AG, and 43% SG). Intraocular foreign bodies (IOFBs) were present in 61 (27.8%) cases [21 (33.3%) PG, 38 (29.9%) AG, and 2 (3.6%) SG]. In our data, 29 of 63 (46.0%) pediatric cases, 76 of 127 (59.8%) adult cases, and 17 of 56 (30.4%) senior cases underwent vitrectomy. In the child and senior age groups, no significant predictors for vitrectomy were identified. In the adult group, diabetes without chronic complications (p = 0.047, HR = 12.42, 95% CI: 1.03-149.39) and the presence of an IOFB (p = 0.005, HR = 6.52, 95% CI: 1.75-24.29) were significant predictors of undergoing vitrectomy; hypertension (p = 0.011, HR = 0.17, 95% CI: 0.04-0.66) was a significant predictor against vitrectomy.
Conclusions :
In our analysis of the NIS Database, we found that IOFBs were more prevalent in the pediatric and adult groups than in the senior group. The adult group was the most likely cohort to undergo vitrectomy for OGI-related endophthalmitis. Furthermore, in adults, diabetes without chronic complications and the presence of an IOFB were both noted to be significant predictors of undergoing vitrectomy.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.