Concurrent Endophthalmitis and Retinal Detachment

Abstract

Eyes with concurrent endophthalmitis and retinal detachment usually have a poor anatomic and visual outcome after treatment. The purpose of this study is to define the relation among the causative organism, the results of retinal detachment repair, and the final visual acuity. Data were retrieved by a retrospective, computer-assisted review of the coded inpatient diagnoses from April 1987 through March 1992. This study included 16 patients (9 males, 7 females) ranging in age from 5 to 88 years (average, 58.7 years). Endophthalmitis was classified as exogenous in 13 (81%) patients and endogenous in 3 (19%). Two groups were identified: a virulent group that included eight (50%) patients (Staphylococcus aureus, streptococci, gram-negative, Bacillus), and a less-virulent group that included eight (50%) patients (Staphylococcus epidermidis, Propionibacterium acnes, fungal). The initial surgical procedure consisted of diagnostic vitreous fluid collection by pars plana vitrectomy (11 cases), anterior vitrectomy (1 case), or vitreous aspiration (4 cases). Additional initial adjunctive surgical procedures included pars plana lensectomy (2 cases), scleral buckling (6 cases), fluid-gas exchange (7 cases), and intraocular antibiotic injections (9 cases). In six (75%) of eight patients with endophthalmitis in the virulent group, the retina remained detached. However, in seven (88%) of eight patients with endophthalmitis in the less-virulent group, the retina remained reattached postoperatively, and the remaining patient had a stable, nonprogressive peripheral tractional retinal detachment. None of the eight patients with endophthalmitis in the virulent group retained a postoperative visual acuity of better than 3/200, and four (50%) lost all light perception. Five (62%) of the eight patients with endophthalmitis in the less-virulent group retained a postoperative visual acuity of 5/200 or better, and none lost all light perception. Concurrent endophthalmitis and retinal detachment patients with virulent organisms have a poor prognosis. Visual and anatomic outcomes were better in the less-virulent group.