Endophthalmitis associated with microbial keratitis.
OBJECTIVE
The purpose of the study is to investigate possible risk factors, organisms cultured, and visual acuity outcomes of endophthalmitis associated with microbial keratitis.


METHODS
Records were reviewed of all patients with both positive corneal and positive intraocular cultures at the Bascom Palmer Eye Institute between January 1, 1990, and March 31, 1995.


RESULTS
Thirteen (92.9%) of 14 patients identified had documented keratitis before the diagnosis of endophthalmitis was made. Thirteen (92.9%) patients recently had used 1% prednisolone acetate eye drops, 2 (14.3%) received oral prednisone, and 5 (35.7%) were being treated for systemic conditions associated with relative immune dysfunction. Eight (57.1%) patients had a history of ocular surgery, and seven (50.0%) had wound abnormalities. Eight (57.1%) patients lacked an intact posterior capsule, four (28.6%) had a corneal perforation, and three (21.4%) had a history of dry eye. Gram-negative organisms (7), Staphylococcus aureus (3), streptococcal species (2), and fungi (4) were the most frequently isolated organisms. Coagulase-negative staphylococci were not isolated. Six (42.9%) patients achieved a post-treatment visual acuity of 20/200 or better. Three (21.4%) patients underwent enucleation or evisceration. Although not statistically significant, there was an association between appropriate initial antibiotic therapy and improved visual outcomes.


CONCLUSIONS
Patients in whom endophthalmitis associated with microbial keratitis develops have a frequent history of corticosteroid use, systemic conditions associated with relative immune dysfunction, lack of an intact posterior capsule, dry eye, wound abnormalities, and/or corneal perforation. In general, agents cultured consisted of organisms less frequently reported to be the causative agents in series of postoperative and post-traumatic endophthalmitis. Post-treatment visual outcomes generally were poor.
Scott
I U
IU
Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami School of Medicine, FL, USA.
Flynn
H W
HW
Feuer
W
W
Pflugfelder
S C
SC
Alfonso
E C
EC
Forster
R K
RK
Miller
D
D
D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001419:Bacteria / Q000302:isolation & purification; D003320:Corneal Ulcer / Q000188:drug therapy / Q000382:microbiology* / Q000503:physiopathology; D009877:Endophthalmitis / Q000188:drug therapy / Q000382:microbiology* / Q000503:physiopathology; D015818:Eye Infections, Bacterial / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D015821:Eye Infections, Fungal / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D005658:Fungi / Q000302:isolation & purification; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009883:Ophthalmic Solutions; D011239:Prednisolone / Q000031:analogs & derivatives / Q000627:therapeutic use; D011241:Prednisone / Q000627:therapeutic use; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D014792:Visual Acuity
D000893:Anti-Inflammatory Agents; D009883:Ophthalmic Solutions; C009935:prednisolone acetate; D011239:Prednisolone; D011241:Prednisone