Endophthalmitis after deadly-weapon-related open-globe injuries: risk factors, value of prophylactic antibiotics, and visual outcomes.
OBJECTIVE
To identify clinical and microbiologic factors influencing the prevalence and visual outcomes in endophthalmitis after deadly-weapon-related open-globe injuries.


METHODS
In a retrospective study of 228 eyes of 212 patients with deadly-weapon-related open-globe injuries, clinical and microbiologic factors influencing the prevalence and visual outcome in endophthalmitis were analyzed in detail.


RESULTS
Twenty-nine eyes enucleated for irreparable damages at presentation were excluded. Nineteen eyes (18 patients) of 199 (186 patients) were associated with culture-proven endophthalmitis. Presence of grade 4 injury, a variable of Ocular Trauma Classification System, and lens disruption at presentation were the significant risk factors for development of endophthalmitis (P =.001; odds ratio = 15.9 [2.0 to 122.1]), and ([P <.001; odds ratio = 17.7 [2.3 to 136.3]), respectively. Favorable outcome (visual acuity of 5/200 or better) was achieved in only four eyes (21%). Five eyes (26.3%) were phthisical, and five eyes (26.3%) were enucleated or eviscerated. All eyes were under the coverage of prophylactic intravenous antibiotics when culture positivity was obtained. Except two eyes with Acinetobactersp., all were infected by gram-positive micro-organisms (89.5%), the most common of which (42%) was Staphylococcus epidermidis. None of the clinical characteristics and treatment modalities affected final visual outcome. Favorable outcome was associated with infection by the less virulent micro-organism S. epidermidis (P =.018; odds ratio = 0.50 [0.25 to 1.00]).


CONCLUSIONS
Endophthalmitis after deadly-weapon-related open-globe injuries has a dismal visual prognosis. Severity of injury and lens disruption are significant risk factors for development of endophthalmitis. Infection with a less virulent microbe is the only factor associated with favorable outcome.
Sabaci
Güngör
G
Department of Ophthalmology, GATA Gülhane Military Medical Academy and Medical School, Ankara, Turkey. gsobaci@gata.edu.tr
Bayer
Atilla
A
Mutlu
F Mehmet
FM
Karagül
Suat
S
Yildirim
Erol
E
D000328:Adult; D000900:Anti-Bacterial Agents; D019072:Antibiotic Prophylaxis; D004359:Drug Therapy, Combination / Q000627:therapeutic use*; D009877:Endophthalmitis / Q000209:etiology* / Q000382:microbiology / Q000517:prevention & control; D015353:Eye Enucleation; D005129:Eye Foreign Bodies / Q000209:etiology* / Q000382:microbiology / Q000517:prevention & control; D015818:Eye Infections, Bacterial / Q000209:etiology* / Q000382:microbiology / Q000517:prevention & control; D015807:Eye Injuries, Penetrating / Q000150:complications* / Q000601:surgery; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D008889:Military Personnel; D009915:Orbit / Q000293:injuries; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012421:Rupture; D014792:Visual Acuity; D014948:Wounds, Gunshot / Q000150:complications* / Q000601:surgery
D000900:Anti-Bacterial Agents