Treatment strategies for postoperative Propionibacterium acnes endophthalmitis☆
Section snippets
Methods
We retrospectively reviewed the clinical charts and microbiology files of all patients treated at Wills Eye Hospital between January 1991 and April 1998 with culture-proven P. acnes endophthalmitis after cataract extraction and posterior chamber IOL implantation. The following data were collected for each patient: age; gender; presenting clinical features associated with the development of endophthalmitis; interval between surgery and onset of signs and symptoms; results of microbiologic
Results
Twenty-five patients met the inclusion criteria and participated in this study. Demographic data and presenting clinical features are presented in Table 1. Fourteen (56%) of the 25 patients were men; the average patient age was 69 years (range, 42–84 years). The average period between cataract extraction and onset of signs and symptoms of P. acnes in the 20 patients in whom this could be reliably determined was 18 weeks (range, 2 days–16 months); in many cases, it was difficult to distinguish
Discussion
Propionibacterium acnes is a gram-positive, anaerobic, pleomorphic bacillus that is part of the normal eyelid and conjunctival flora.6, 7, 8, 9 A fastidious organism,10 it is often difficult to culture; many cases of suspected P. acnes endophthalmitis, based on characteristic clinical presentation and microscopic examination of intraocular specimens, were not included in this study as they were culture-negative. Newer molecular biologic techniques such as the polymerase chain reaction have
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Supported by the Heed Foundation, Cleveland, Ohio (GKS).