Endophthalmitis caused by the coagulase-negative staphylococci. 1. Disease spectrum and outcome.
OBJECTIVE
The coagulase-negative staphylococci are the most common causes of postoperative endophthalmitis. This study investigates the variability in the disease spectrum and visual outcome of coagulase-negative staphylococcal endophthalmitis in a large, single-center series.


METHODS
Ninety consecutive cases of coagulase-negative staphylococcal endophthalmitis were investigated retrospectively from two time periods, 1978 to 1982 and 1985 to 1987, separated by a transitional period in cataract surgery technique. Using a detailed protocol, inpatient, outpatient, and microbiologic records were analyzed. Six-month visual acuity results were obtained.


RESULTS
Diagnosis frequently was delayed, often suspected only after hypopyon development. Thirty-seven percent of patients presented more than 1 week after the inoculating event, and 13% presented after more than 1 month. Variable asymptomatic intervals and gradually worsening inflammatory prodromes are noted. Painless endophthalmitis occurred in 16%. Non-epidermidis infections comprised 28%. With vitrectomy/intraocular antibiotic management, 38% and 68% achieved visual acuities of 20/50 and 20/400, respectively. Overall, 10% of patients developed late retinal detachments. This occurred in only 4% of patients, with endophthalmitis occurring after cataract surgery.


CONCLUSIONS
Ophthalmologists should become familiar with the emerging concepts of delayed-onset, chronic, and often painless endophthalmitis in which the coagulase-negative staphylococci play a prominent role.
Schepens Eye Research Institute, Harvard University Medical School, Boston, MA.
L D
LD
Ormerod
D D
DD
Ho
L E
LE
Becker
R J
RJ
Cruise
H I
HI
Grohar
B G
BG
Paton
A R
AR
Frederick
T M
TM
Topping
J J
JJ
Weiter
S M
SM
Buzney
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D003030:Coagulase / Q000378:metabolism; D009877:Endophthalmitis / Q000188:drug therapy / Q000382:microbiology* / Q000473:pathology; D015818:Eye Infections, Bacterial / Q000188:drug therapy / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000473:pathology; D013210:Staphylococcus / Q000201:enzymology / Q000302:isolation & purification; D016896:Treatment Outcome; D014792:Visual Acuity
D000900:Anti-Bacterial Agents; D003030:Coagulase