Acute-onset endophthalmitis after clear corneal cataract surgery (1996-2005). Clinical features, causative organisms, and visual acuity outcomes.
OBJECTIVE
To report the clinical features, causative organisms, and visual acuity outcomes associated with endophthalmitis after clear corneal cataract surgery and to compare outcomes with those of the Endophthalmitis Vitrectomy Study (EVS).


METHODS
Retrospective consecutive case series.


METHODS
The study included 73 eyes of 73 patients, mean age 76 years (range, 48-94 years), with endophthalmitis after clear corneal cataract surgery, including both referred and in-house patients.


METHODS
The clinical and microbiology records were reviewed of all patients treated at a single medical center between January 1, 1996, and December 31, 2005, for clinically diagnosed, culture-positive endophthalmitis occurring within 6 weeks of clear corneal cataract surgery.


METHODS
Presence of hypopyon, mean time to endophthalmitis diagnosis, organisms cultured, and presenting and final visual acuities.


RESULTS
The mean time between cataract surgery and diagnosis of endophthalmitis was 13 days (median, 9 days; range, 1-39 days). Visual acuity at the time of diagnosis was <5/200 in 61 of 73 (83.6%) patients, including light perception in 11 of 73 (15.1%). Hypopyon was present in 60 of 73 (82.2%) eyes. The initial treatment included intravitreal vancomycin, ceftazidime, and dexamethasone. A vitreous tap and intravitreal injection was performed in 54 of 73 (74.0%) eyes and pars plana vitrectomy in 19 of 73 (26.0%) eyes. Coagulase-negative Staphylococcus was isolated in 50 of 73 (68.4%) eyes. Other isolates included Staphylococcus aureus in 5/73 (6.8%) and Streptococcus species in 6 of 73 (8.2%). A visual acuity of > or =20/40 was achieved in 36 of 73 patients (49.3%) at final follow-up.


CONCLUSIONS
The features and outcomes of endophthalmitis associated with clear corneal cataract surgery are similar to those reported in the EVS, which are associated with scleral incisions, but time to diagnosis was later with clear corneal incisions.
Lalwani
Geeta A
GA
Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida 33136, USA. glalwani@med.miami.edu
Flynn
Harry W
HW
Scott
Ingrid U
IU
Quinn
Carolyn M
CM
Berrocal
Audina M
AM
Davis
Janet L
JL
Murray
Timothy G
TG
Smiddy
William E
WE
Miller
Darlene
D
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000627:therapeutic use; D002442:Ceftazidime / Q000627:therapeutic use; D003315:Cornea / Q000601:surgery*; D003907:Dexamethasone / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D009877:Endophthalmitis / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D015818:Eye Infections, Bacterial / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D006801:Humans; D007267:Injections; D008875:Middle Aged; D018918:Phacoemulsification / Q000379:methods*; D011183:Postoperative Complications; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D013997:Time Factors; D014640:Vancomycin / Q000627:therapeutic use; D014792:Visual Acuity / Q000502:physiology*; D014821:Vitrectomy; D014822:Vitreous Body / Q000382:microbiology
D000890:Anti-Infective Agents; D014640:Vancomycin; D003907:Dexamethasone; D002442:Ceftazidime