[Vitrectomy for endophthalmitis after cataract surgery].
OBJECTIVE
To identify risk factors of poor visual outcome with vitrectomy for early-onset endophthalmitis after cataract surgery.


METHODS
Clinical records of 29 consecutive eyes with endophthalmitis developing within 6 weeks after cataract surgery and that underwent therapeutic vitrectomy between June 1996 and April 2001 were retrospectively reviewed. Twenty-two of the eyes received intravitreal injections of vancomycin and ceftazidime at the time of vitrectomy, and all patients received intravenous antibiotics. Eyes were divided into two groups; group A consisted of 22 eyes with a final visual acuity of 0.2 or greater, and group B consisted of 7 eyes with a final visual acuity of less than 0.2.


RESULTS
Fifteen eyes (52%) in group A achieved a visual acuity of 0.5 or better and 8(28%) achieved a visual acuity of 1.0, while 4 eyes in group B developed phthisis bulbi. For eyes with a preoperative visual acuity of hand motions or worse, there was no correlation between final visual acuity and preoperative visual acuity. The overall culture-positive rate was 57%. In group A, methicillin-resistant Staphylococcus epidermidis was identified in 6 eyes, methicillin-resistant Staphylococcus aureus (MRSA) in 3 eyes and enterococcus in 2 eyes. In group B, alpha-hemolytic streptococcus (AHS) was identified in 4 eyes, aspergillus in 1 eye, and MRSA in 1 eye. All isolates were sensitive to vancomycin with the exception of the aspergillus. AHS infection appeared to be associated with wound failure from the initial cataract surgery and a poor visual outcome. Among 3 of the eyes that developed phthisis bulbi, intravitreal injection of antibiotics was not performed.


CONCLUSIONS
Early vitrectomy and intravitreal injection of vancomycin may improve visual outcomes, but infection with AHS may be associated with cataract surgery wound failure and poor visual outcomes.
Oshitari
Kazuhiro
K
Department of Ophthalmology, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka 181-8611, Japan.
Hirakata
Akito
A
Okada
Annabelle A
AA
Hida
Tetsuo
T
Oda
Hitoshi
H
Miki
Daijiro
D
Nagamoto
Toshiyuki
T
Fujiwara
Takaaki
T
D000368:Aged; D000369:Aged, 80 and over; D002387:Cataract Extraction; D009877:Endophthalmitis / Q000209:etiology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D013290:Streptococcal Infections / Q000628:therapy; D016896:Treatment Outcome; D014640:Vancomycin / Q000627:therapeutic use; D014792:Visual Acuity; D014821:Vitrectomy
D014640:Vancomycin