Endophthalmitis: Review of 77 Consecutive Cases

Yosanan Yospaiboon, M.D.
Julaporn Sangvijit, M.D.
Chamkad Suwanwatana, M.D.
Department of Ophthalmology, Faculty of Medicine, Khonkaen University, Khonkaen

 Excerpt from the article:

INTRODUCTION

Endophthalmitis is the inflammatory disease of the intraocular tissue that often results in severe visual loss. The infection may occur after penetrating trauma and recent intraocular surgery, or originate from the bloodstream, usually by metastasis from distant foci of infection. In the past, most patients with endophthalmitis usually ended up with poor visual results or had their eyes removal. With the use of effective intraocular antibiotics and advance in vitreous surgery, the final visual outcome at present is markedly im proved. Regarding the frequency of isolates of specific causative microorganisms in endophthalmitis, there have been no documented reports in Thai patients. To characterize this spectrum of causative pathogens, the visual outcome, and also to identify the factors affecting the prognosis, a six-year retrospective study of patients with endophthalmitis at a large referral center in northeastern Thailand was conducted.

PATIENTS AND METHODS

We reviewed all cases of suspected endophthalmitis treated at Srinagarind hospital, Khon Kaen University, from 1983 through 1988. The patients' data including age, sex, occupatiom, history of ocular injuries, previous treatment and duration of the symptoms were recorded. The ocular examination included affected side, anterior chamber reaction, pres ence of hypopyon, vitreous haze, status of retina and presence of intraocular foreign bodies.Smears and cultures were prepared from anterior chamber paracentesis and/or vitreous tapping. The smears were treated with Gram staining and KOH wet preparation. Cultures were plated on blood agar, chocolate agar, McConkey agar incubated at 37 c for bacterial isolation. Sabouraud's dextose agar and blood agar were incubated at 25 c to enhance fungal growth. Intraocular antibiotics were administered at the time of anterior chamber paracentesis and/or vitreous tapping. Vitrectomy and/or lensectomy were performed, if indicated, during the operations. If aspirate from vitrectomy was to be cultured, the material suctioned through the instru ment was collected in a sterile bottle. The specimen was then centrifuged and the sediment was used for smear and culture. In cases of painful blind eyes, more extensive surgery, enu cleation or evisceration, was performed instead, and the causa tive microorganisms may be isolated from these removed eyes.All patients were given antimicrobial therapy. The choice of antibiotics or combination was guided by the initial smear from anterior chamber paracentesis and/or vitreous tapping. In negative cases, the selection was determined by speculating as to the probable organisms. Topical antibiotics commonly used were neomycin-polymyxin-grarnicidine combination and gentamicin. Cefazolin (50 mg/ml) and fortified gentamicin (13.5 mg/ml) were tried in recent cases. In most patients systemic coverage was used commonly an aminoglycoside (gentamicin) combined with a penicillin or a cepharosporin. Except for enucleated or eviscerated cases, subconjunctival antibiotics were injected, commonly gen tamicin 20 mg and cefazolin lOO mg, at the time of anterior chamber paracentsis and/or vitreous tapping. these patients also recieved intraocular antibiotics, gentamicin 0.1 mg and cefazolin 2.25 mg. If fungal endophthalmitis was docu mented, intraocular amphotericin B 5-10 mcg. added. Corticosteroids were not used in this study.

Thai J Ophthalmol 1988; 2(2): 63