Endophthalmitis after Cataract Surgery: Changes in Management Based on Microbiologic Cultures

Abstract

To assess the utility of microbiologic culture data for the management of endophthalmitis after cataract surgery. Retrospective, single-center, cohort study. All patients treated for endophthalmitis after cataract surgery between January 1, 2014, and December 31, 2017, at a single institution. Endophthalmitis cases were determined from billing records and confirmed with chart review. A change in clinical management was defined as additional intravitreal antibiotic injections or pars plana vitrectomy. A change in clinical management within 2 weeks of initial endophthalmitis culture and treatment; visual acuity (VA). A total of 111 eyes of 111 patients were treated for endophthalmitis after cataract surgery, of which 57 (51%) were culture-positive. After initial treatment of endophthalmitis, a change in clinical management after vitreous culture occurred in 9 of 111 eyes (8%), including 6 of 57 (11%) culture-positive eyes compared with 3 of 54 (6%) culture-negative eyes (P= 0.49). Change in clinical management for culture-positive eyes was based on declining vision (3 eyes), worsening clinical examination results (2 eyes), and retinal detachment (1 case). Change in clinical management for culture-negative endophthalmitis eyes was based on worsening clinical examination results (2 eyes) and declining vision (1 eye). No additional interventions were initiated on the basis of positive culture results. At final follow-up, mean logarithm of the minimum angle of resolution (logMAR) VA was 1.09 (∼20/250) for the culture-positive eyes compared with 0.59 (∼20/80) for culture-negative eyes (adjusted difference, 0.394; 95% confidence interval, 0.02-0.77, P= 0.03). Rhegmatogenous retinal detachments (RRDs) or retinal tears occurred in 19 of 111 eyes (17%) after developing endophthalmitis, and culture-positive eyes developed a secondary RRD in 11 of 57 eyes (19%) compared with 3 of 54 (6%) culture-negative eyes (P= 0.03). After endophthalmitis related to cataract surgery, vitreous cultures may have prognostic value for final visual outcomes but have a limited effect on clinical management.