Risk factors for post-traumatic endophthalmitis in patients with positive intraocular cultures.
OBJECTIVE
To determine the risk factors for post-traumatic endophthalmitis in patients with positive intraocular culture.


METHODS
An institutional-based prospective nonrandomized interventional study of patients older than 15 years who presented for primary repair of open globe injury between June 2003 and April 2005 was undertaken. The main outcomes measured were initial and final visual acuity, type of injury, presence of uveal and vitreous prolapse, time interval between injury and primary repair of the globe, length of wound, location of wound, and virulence of organism. Statistical analysis tests used were Student t-test, Fisher exact test, and chi-square test.


RESULTS
Fifty patients were included in the study. They were divided into two groups: Group 1 (n=19) patients, who developed clinically significant endophthalmitis; and Group 2 (n=31) patients, who did not develop clinically significant endophthalmitis. Delay in primary repair more than 36 hours (p=0.042), length of wound more than 8 mm (p=0.050), and isolation of organisms like fungus (p=0.006, OR=14), Bacillus cereus (p=0.01, OR=11.25), and Pseudomonas aeruginosa (p=0.05-0.10, OR=11.3) significantly increased the risk of endophthalmitis. Mean initial and final visual acuity was better in Group 2 but was not statistically significant (p=0.21).


CONCLUSIONS
Final visual outcome in the presence of positive intraocular culture is poor. Isolation of virulent organisms, longer length of laceration, and delayed primary repair of open globe injuries have high risk of developing endophthalmitis. Prophylactic intraocular antibiotics should be considered in cases with longer length of wound and delayed primary closure.
Department of Ophthalmology and Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry 605 006, India. arvind_ophthal@yahoo.co.in
A
A
Gupta
R
R
Srinivasan
D
D
Gulnar
K
K
Sankar
T
T
Mahalakshmi
D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D001419:Bacteria / Q000302:isolation & purification; D009877:Endophthalmitis / Q000175:diagnosis / Q000382:microbiology* / Q000517:prevention & control; D005128:Eye Diseases / Q000175:diagnosis; D015818:Eye Infections, Bacterial / Q000175:diagnosis / Q000382:microbiology* / Q000517:prevention & control; D015821:Eye Infections, Fungal / Q000175:diagnosis / Q000382:microbiology* / Q000517:prevention & control; D015807:Eye Injuries, Penetrating / Q000175:diagnosis / Q000382:microbiology* / Q000517:prevention & control; D005260:Female; D005658:Fungi / Q000302:isolation & purification; D006801:Humans; D008297:Male; D011391:Prolapse; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D014603:Uveal Diseases / Q000175:diagnosis; D014792:Visual Acuity; D014822:Vitreous Body / Q000473:pathology
D000900:Anti-Bacterial Agents