Surgical wound defects associated with endophthalmitis.
Twenty-five consecutive cases of culture-proven postsurgical endophthalmitis were evaluated. Patients underwent wound revision and pars plana vitrectomy with intravitreal antibiotic and steroid infusion (gentamicin 8 micrograms/cc, clindamycin 9 micrograms/cc, dexamethasone 8 micrograms/cc) and injection (gentamicin 100 micrograms plus clindamycin 200 micrograms [and amphotericin 5 micrograms in one case] and dexamethasone 800 to 1000 micrograms). Twenty cases demonstrated wound defects (eg, wound gape/malapposition, abscess/tissue necrosis, suture dehiscence, leak, vitreous wick). Culture-proven isolates included both gram negative and positive bacteria and fungi. Visual acuity improved in 18 of the 20 (90%) gram positive cases. Ten of the 17 (59%) patients in the Staphylococcus epidermidis subgroup achieved a visual acuity of 20/50 or better. Surgical wound defects are frequently associated with culture-proven endophthalmitis. When vitrectomy is included as part of the treatment regimen, we recommend meticulous inspection and closure of any defective surgical wounds associated with endophalmitis.
Maxwell
D P
DP
Department of Ophthalmology, Tulane University School of Medicine, New Orleans, La 70112-2699.
Diamond
J G
JG
May
D R
DR
D002387:Cataract Extraction; D009877:Endophthalmitis / Q000150:complications*; D006801:Humans; D007910:Lenses, Intraocular; D011183:Postoperative Complications / Q000209:etiology*; D013530:Surgical Wound Infection / Q000150:complications*; D014792:Visual Acuity; D014821:Vitrectomy; D014945:Wound Healing