title: Management and outcomes of postoperative endophthalmitis since the endophthalmitis vitrectomy study: the Endophthalmitis Population Study of Western Australia (EPSWA)'s fifth report.
abstract: OBJECTIVE
  To examine if changes in the diagnosis and management of postoperative endophthalmitis have occurred since 1995, and to identify factors that might predict final visual outcome.
  
  
  METHODS
  Retrospective, population-based, noncomparative, consecutive case series.
  
  
  METHODS
  Patients with clinically diagnosed endophthalmitis after cataract surgery and lens-related surgery in Western Australia from 1980 to 2000.
  
  
  METHODS
  Endophthalmitis cases were identified using record linkage and cross-referencing with the surgical logbooks of vitreoretinal surgeons before validation by medical record review.
  
  
  METHODS
  Microbiological data (microorganisms isolated and antibiotic susceptibilities), diagnostic interventions, surgical procedures, therapeutic interventions, and visual acuity (VA).
  
  
  RESULTS
  During the 21-year period, 213 episodes of endophthalmitis occurred after cataract surgery. Since 1995, both anterior chamber sampling and vitreous sampling have increased significantly. The overall use of vitrectomy has also increased, but we did not observe a difference according to presenting VA. Intravitreal antibiotic use increased significantly, whereas the use of both subconjunctival and IV antibiotics decreased. In one third of patients, the VA at least 6 months after admission for endophthalmitis was worse than 6/18. This was associated with treatment that did not include the use of oral antibiotics (odds ratio [OR], 3.86; 95% confidence interval [CI], 1.21-12.39; P = 0.02), growth from intraocular samples of organisms other than coagulase-negative staphylococci (OR, 9.84; 95% CI, 2.84-34.09; P<0.001), and a discharge VA worse than 6/18 (OR, 6.10; 95% CI, 1.63-22.89; P = 0.01).
  
  
  CONCLUSIONS
  Although we observed noticeable changes in the diagnosis and management of endophthalmitis since 1995, visual outcomes have not improved and remain poor. Our finding that treatment with oral antibiotics may be associated with a better visual outcome warrants further investigation.
authors.affiliation: School of Population Health, The University of Western Australia, Crawley, Australia.
authors.forename: Jonathon Q
authors.initials: JQ
authors.lastname: Ng
authors.forename: Nigel
authors.initials: N
authors.lastname: Morlet
authors.forename: John W
authors.initials: JW
authors.lastname: Pearman
authors.forename: Ian J
authors.initials: IJ
authors.lastname: Constable
authors.forename: Ian L
authors.initials: IL
authors.lastname: McAllister
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Kennedy
authors.forename: Timothy
authors.initials: T
authors.lastname: Isaacs
authors.forename: James B
authors.initials: JB
authors.lastname: Semmens
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001082:Aqueous Humor / Q000382:microbiology; D001419:Bacteria / Q000302:isolation & purification; D002387:Cataract Extraction; D009877:Endophthalmitis / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy*; D015818:Eye Infections, Bacterial / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome; D014792:Visual Acuity; D014821:Vitrectomy; D014822:Vitreous Body / Q000382:microbiology; D014904:Western Australia
chemical_list: D000900:Anti-Bacterial Agents