Cases Of Postoperative Endophthalmitis Research Articles

A retrospective review of endophthalmitis due to coagulase-negative staphylococci.

We retrospectively reviewed 28 cases of postoperative endophthalmitis due to coagulase-negative staphylococci. There was an average delay between surgery and the acute presentation of 7 X 2 days (SD 3 X 3). All patients were treated with intraocular antibiotics (IOAB) or therapeutic vitrectomy with IOAB. In six of the 28 cases the organisms were resistant to gentamicin as measured by the Kirby-Bauer technique; none was resistant to cephalosporins. Isolates that had been stored by lyophilisation were reconstituted and tested by serial dilution; none was resistant to gentamicin, though two were borderline. The final visual acuity was 6/18 or better in 72% of the eyes.

Results in the Treatment of Postoperative Endophthalmitis

A retrospective study of 40 cases of postoperative endophthalmitis was conducted between July 1979 and May 1981. Treatment consisted of topical, periocular, and systemic antibiotics, as well as the use of intraocular antibiotic injection in all cases. In addition, 22 cases had a diagnostic and therapeutic vitrectomy. The cases selected for vitrectomy included cases with worse presenting visual acuity, higher percentage of positive culture results, and more virulent organisms. Because of a poor clinical response to initial therapy, 13 cases had repeat intraocular cultures performed between 24 and 72 hours at the time of repeat intraocular antibiotic injection. All 13 repeat intraocular cultures were negative. Complications of the treatment included four retinal detachments (three in the vitrectomy group). In the culture-positive cases, a final visual acuity of 20/400 or better was achieved in 13 of 29 cases (45%), and complete loss of vision (NLP) resulted in 10 of the 29 cases (34%).

Anterior chamber paracentesis. Diagnostic value in postoperative endophthalmitis.

The results of 115 anterior chamber paracenteses were reviewed. Of these, 14 had been performed for diagnostic purposes in postoperative endophthalmitis. Cultures of aqueous from five of the 14 were positive. Staphylococcus aureus was recovered from three, paracolon bacillus from one, and Bacillus subtilis from one. A polymorphonuclear cell reaction characterized all cases of postoperative endophthalmitis from which bacteria were recovered. Since one third of the eyes with postoperative endophthalmitis in this series contained culturable bacteria, we consider anterior chamber paracentesis a valuable tool in the diagnosis of the etiology of postoperative endophthalmitis.

Experiences with Five Cases of Postoperative Endophthalmitis

Experiences with Five Cases of Postoperative Endophthalmitis

Prophylactic subconjunctival penicillin and streptomycin after cataract extraction.

As a result of Sorsby's reports * suggesting that subconjunctival injections of penicillin could prevent experimental production of endophthalmitis by susceptible organisms, it became the practice of several services at the Illinois Eye and Ear Infirmary during 1949 to administer penicillin subconjunctivally as a prophylactic measure at the completion of cataract extractions. During 1952 streptomycin was added to the subconjunctival preparation to increase its bacterial range. This modification was made because of the unfortunate occurrence during one afternoon of three consecutive cases of postoperative endophthalmitis due to Aerobacter aerogenes, which proved to be penicillin-resistant. A total of 1202 cases had prophylactic penicillin injections, and in 3226 cases the injection contained both penicillin and streptomycin. During the immediately preceding period and the early part of the same period some services at the Infirmary did not use any prophylactic injection, and these cases, totaling 1773, form the control series. TECHNIQUE The penicillin-streptomycin solution