Clinical observations of acute-onset endophthalmitis after clear corneal phacoemulsification

Abstract

To evaluate the incidence of acute-onset endophthalmitis after clear corneal phacoemulsification and to report its clinical features, microbiology, and therapeutic efficacy. It was a retrospective case series study. Medical records were reviewed for all patients diagnosed with acuteonset postoperative endophthalmitis from 2006 through 2013 associated with cataract surgery at Shandong Eye Institute of China. The 8-year frequency of acute-onset endophthalmitis after clear corneal phacoemulsification was 0.13%. The mean time between cataract extraction and endophthalmitis onset was 6 days (median, range 1 to 37 days). Endophthalmitis onset occurred within 7 days in 57.1%. The incidence was significantly higher in summer (0.25%) than in other seasons seasons (F=8.61, P=0.05). The incidence in diabetes was 0.06% , and in non-diabetic patients was 0.16% (F=1.51, P=0.23). There were no significantly difference (F=0.003, P=0.422, ) in the endophthalmitis rates between those with capsular rupture (0.24%)and those without (0.13%). Three of the 21 cases (14.3%) were cured by antibiotic agents only. Antibiotic irrigation of the capsular bag was taken in 8 patients (38.1%). Six patients (28.6%) had both antibiotic irrigation of the capsular bag and intravitreal injection of the antibiotics and the other 4 patients (19.0%) were cured by vitreous surgery. Cultures were positive in 33.3% of cases with aqueous humor samples and in 16.7% of cases with vitreous biopsy. The culture isolates showed Staphylococcus species in 2 eyes, while Pseudomonas paucimobilis, Corynebacterium xerose, Neisseria mucosa and Enterococcus faecalis in 1 eye respectively. Sixteen patients (76.2%) achieved a final visual acuity of 20/40 or better. Five (23.8%) had worse than 20/40 to better than 20/200. No eyes were eviscerated. Early recognition and appropriate treatment are the most important factors in the successful management of endophthalmitis.