Abstract
BackgroundEndophthalmitis is potentially devastating intraocular inflammation following eye trauma or surgery. We describe the visual outcomes and causative pathogens in acute bacterial postoperative and posttraumatic endophthalmitis treated with immediate pars plana vitrectomy (PPV) with Vancomycin dissolved in the infusion fluid.MethodsClinical records of consecutive 30 patients with postoperative endophthalmitis and 15 patients with posttraumatic endophthalmitis were evaluated. Vancomycin was administered constantly in the infusion fluid at the time of complete PPV. Cultures were prepared from anterior chamber paracentesis. The mean follow-up period was 13 months.ResultsThe visual acuities were improved in 38 cases (84 %) and remained stable in seven cases (16 %). Median post-PPV visual acuity was 1.0 logMAR in a group with postoperative endophthalmitis and 1.3 logMAR in a group with posttraumatic endophthalmitis (p < 0.05). Twenty cases (44 %) were culture-positive (Staphylococcus, Streptococcus, Enterococcus and Bacillus spp).ConclusionsEarly PPV with Vanomycin in infusion leads to vision improvement in patients with both posttraumatic and postoperative endophthalmitis. In our series of 45 cases culture was positive only in half of the cases.
Highlights
Endophthalmitis is potentially devastating intraocular inflammation following eye trauma or surgery
In the present study we retrospectively evaluated data of patients with endophthalmitis following intraocular surgery and open globe eye trauma treated with immediate 23G pars plana vitrectomy (PPV) with Vancomycin dissolved in the infusion fluid
The Endophthalmitis Vitrectomy Study (EVS) – the major randomized trial in this subject - published in 1995 recommended intravitreal antibiotics if the visual acuity is greater than hand motion and PPV if visual acuity is equal to light perception [11]
Summary
Endophthalmitis is potentially devastating intraocular inflammation following eye trauma or surgery. Endophthalmitis is a severe and potentially devastating intraocular purulent inflammation resulting from infectious agent invasion to the posterior segment of the eye occurring as a complication of an operation procedure, penetrating eye injuries or hematogenous spread of bacteria [1]. 70 % of cases occur as a complication of the intraocular surgery, mostly cataract extraction. Capsular or zonular surgical complication and wound leak on the day after surgery are the main risk factors for the postoperative endophthalmitis [2]. Rural setting [5], delayed wound closure [6] and dirty wound [7] are the main risk factors for endophthalmitis after penetrating eye trauma. Other risk factors are: retained intraocular foreign body (IOFB) [6] and ruptured lens capsule [4]
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