Evaluation of outcome of various treatment methods for endogenous endophthalmitis.
OBJECTIVE
To evaluate the role of different treatment methods (intravitreal antibiotics and vitrectomy) for endogenous endophthalmitis and assess the outcome. Materials and0


METHODS
This is a retrospective observational case study. Sixteen cases of endogenous endophthalmitis noted in 14 patients between October 2000 and April 2004 were reviewed. Two patients had bilateral disease. Patients were followed up for a mean of 3 months (range, 1-12 months).


RESULTS
Vitreous and aqueous cultures were positive in 8 (66%) cases and 3 (75%) cases respectively. Fungal isolates occurred in 4 (33%) cases, out of which 3 were due to candida, gram-positive isolates occurred in 2 (16%) and gram-negative isolates in 2 (16%) of the cases. Initial treatment included vitreous tap and injection of intravitreal medication in 12 (75%) cases and pars plana vitrectomy with injection of intravitreal medication in 3 (19%) cases. Final visual outcomes were obtainable for13 cases (1 patient died and 1 patient was lost to follow-up and 1 eye was eviscerated). Five (43%) of these cases achieved visual acuity of 6/60 or better and 8 (56%) eyes achieved a visual acuity less than 6/60. Risk factors mainly associated with the disease were uncontrolled diabetes mellitus, chronic renal failure, renal transplant, abdominal surgeries and septicemia.


CONCLUSIONS
Our experience suggests that endogenous endophthalmitis is generally associated with poor visual outcome. Prompt treatment with intravitreal antibiotics and vitrectomy can result in improvement in ocular signs and visual acuity in majority of the patients. The patients with culture-positive endogenous endophthalmitis are more likely to have fungal isolates with a predominance of candida. Fungal endopthalmitis has a poor visual outcome as compared to bacterial endophthalmitis.
Keswani
Tulsi
T
National Institute of Ophthalmology, Pune, India. tulsikes@yahoo.com
Ahuja
Vijay
V
Changulani
Manish
M
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001419:Bacteria / Q000302:isolation & purification; D016022:Case-Control Studies; D009877:Endophthalmitis / Q000382:microbiology* / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D005658:Fungi / Q000302:isolation & purification; D006801:Humans; D007194:India; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014792:Visual Acuity; D014821:Vitrectomy; D014822:Vitreous Body / Q000382:microbiology / Q000601:surgery
D000900:Anti-Bacterial Agents