Abstract
Purpose :
To report on the microbial spectrum and clinical features affecting final visual acuity (VA) outcome in cases of culture-positive endophthalmitis after open globe injury.
Methods :
A non-comparative, retrospective, consecutive case series. All patients were diagnosed with endophthalmitis between January 2016 and January 2020 at the Bascom Palmer Eye Institute. Culture-positive isolates from patients with history of open globe injury were identified. Variables included demographic information, time to diagnosis, mechanism of injury, causative organism, and VA outcomes.
Results :
Eleven cases of culture-positive endophthalmitis after open globe injury were identified. All patients were male and average age at time of injury was 35.65 years. Penetrating trauma was the mechanism of injury in all cases. Treatment selected included intravitreal antimicrobials in 11 cases, initial pars plana vitrectomy in 8 cases, and silicone oil in 4 cases. Primary evisceration or enucleation was not performed in any patient.
Seven cases of endophthalmitis (64%) were clinically diagnosed prior to open globe repair, whereas 4 cases (36%) developed endophthalmitis after open globe repair. The average time from globe injury to presentation was 7.3 days (range 0 to 42 days). Six cases were associated with an intraocular foreign body (IOFB). Of these, 4 were metallic and 2 were composed of vegetable matter.
Coagulase-negative staphylococcus accounted for the majority of cases (55%, 6/11). Isolates included Staphylococcus epidermidis (n=5) and Staphylococcus hominis (n=1). Virulent organisms represented the remainder of cases and isolates included: Streptococcus mitis (n=1), and Bacillus cereus (n=1), Fusarium (n=1), Colletotrichum gloeosporiodes (n=1), and Enterobacter cloacae (n=1).
The mean presenting VA was HM (LogMAR 2.25) and the final average VA was similarly HM (LogMar 2.1) and included 3 enucleations. For patients without an IOFB the mean VA was CF (LogMAR 1.88), as compared to HM (LogMar 2.2) in cases of IOFB.
Conclusions :
In agreement with prior studies on open globe injuries, we found coagulase-negative staphylococcus to be the most commonly isolated organism in cases of culture-positive endophthalmitis. In the current study, delayed presentation to care was a common factor in the development of endophthalmitis. VA outcomes for these patients with open-globe related endophthalmitis is generally poor.
This is a 2021 ARVO Annual Meeting abstract.