Original article
Acute Endophthalmitis After Cataract Surgery: 250 Consecutive Cases Treated at a Tertiary Referral Center in the Netherlands

https://doi.org/10.1016/j.ajo.2009.09.021Get rights and content

Purpose

To evaluate the clinical characteristics, bacterial culture, and visual outcome of patients with acute endophthalmitis after cataract surgery.

Design

Retrospective consecutive interventional case series.

Methods

Clinical notes from patients treated for acute endophthalmitis after cataract surgery in a single center from 1996 to 2006 were reviewed. Patients with less than 1 month of follow-up and missing bacterial cultures were excluded. Vitreous biopsy or primary vitrectomy followed by intravitreal injection of vancomycin and ceftazidime (± prednisolone) was performed. Main outcome measures were bacterial culture and final visual acuity.

Results

Bacterial cultures (total 250 cases) showed bacterial growth in 166 cases (66.4%). From these 166 cultures, 89 (53.6%) revealed gram-positive coagulase-negative, 63 (38.0%) other gram-positive, 10 (6.0%) gram-negative, and 4 (2.4%) polymicrobial cultures. Vitreous biopsy with intravitreal antibiotics injection was performed in 225 (90.0%) of cases. Primary vitrectomy with intravitreal antibiotics was performed in 25 eyes (10.0%). Final visual acuity ≥0.5 was achieved in 129 (51.6%) of all cases, 54 (60.7%) of the 89 gram-positive coagulase-negative cultures, 20 (31.7%) of the 63 other gram-positive cultures, 5 (50.0%) of the 10 gram-negative cultures, and 9 (45.0%) of the 20 Staphylococcus aureus cultures. There was no additional effect for treatment by primary vitrectomy or intravitreal prednisolone.

Conclusions

Treatment outcome after endophthalmitis is highly dependent on the causative organism. Treatment outcomes for gram-negative bacteria and S. aureus may be better than previously reported. Prompt treatment of endophthalmitis remains essential and the role of complete primary vitrectomy remains subject to debate.

Section snippets

Methods

Clinical records of all patients treated for acute postoperative endophthalmitis at Radboud University Nijmegen Medical Centre between January 1, 1996, and December 31, 2006, were reviewed. The study included patients with onset of symptoms within 6 weeks after cataract surgery referred from other hospitals and from our own department. Patients with endophthalmitis following secondary lens implantation or any combined surgery for vitreoretinal disease or glaucoma were excluded.

All patients

Results

During the study interval 286 eyes of 284 patients were treated for acute endophthalmitis after cataract surgery. Excluded were patients with follow-up of less than 1 month (n = 14), patients with presenting visual acuity (VA) of no light perception (n = 3), patients with presenting visual acuity of >0.40 (n = 4), patients who were enrolled in a randomized multicenter trial (n = 2), patients who received only topical treatment (n = 7), patients in whom a bacterial culture was taken but no

Discussion

Despite advances in prophylaxis and surgical treatment techniques, endophthalmitis remains a devastating complication of cataract surgery.2, 6, 10 Treatment outcomes after endophthalmitis are influenced by patient-related items, causative organisms, presenting visual acuity, and treatment type.2 Even though limited by its retrospective nature and incomplete data on the condition of the eye before cataract surgery, the large number of study eyes in our current investigation provides qualified

Benjamin J. Pijl, MD, is a resident at the Radboud University Nijmegen Medical Centre, Institute of Ophthalmology, in Nijmegen, The Netherlands.

References (22)

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Benjamin J. Pijl, MD, is a resident at the Radboud University Nijmegen Medical Centre, Institute of Ophthalmology, in Nijmegen, The Netherlands.

Niels Crama, MD, FEBOpth, is a Vitreoretinal Surgeon at the Radboud University Nijmegen Medical Centre, Institute of Ophthalmology, Nijmegen, The Netherlands.

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