Delayed- versus acute-onset endophthalmitis after cataract surgery.
OBJECTIVE
To report a large consecutive case series of patients who developed delayed-onset and acute-onset endophthalmitis after cataract surgery.


METHODS
Retrospective consecutive case series.


METHODS
The current study is a retrospective consecutive case series of patients treated between January 2000 and December 2009 for culture-proven endophthalmitis after cataract surgery. The study defined 2 groups after cataract surgery: acute-onset endophthalmitis (≤6 weeks after surgery) and delayed-onset endophthalmitis (>6 weeks after surgery).


RESULTS
A total of 118 patients met study criteria; cases included 26 delayed-onset cases and 92 acute-onset cases. The following clinical features and outcomes occurred in delayed- vs acute-onset cases: 1) the presenting visual acuity was ≤5/200 in 31% vs 89%; 2) hypopyon was found in 46% vs 80%; 3) the most frequent isolate was Propionibacterium acnes (11/26) vs coagulase-negative Staphylococcus (57/92); and 4) patients with the most frequent isolate achieved a visual outcome of ≥20/100 in 91% vs 56%. In delayed-onset cases, the intraocular lens was removed or exchanged in 19 of 26 cases (73%). Of these 19 cases, 13 achieved a visual outcome of ≥20/100.


CONCLUSIONS
Patients with delayed-onset endophthalmitis generally presented with better initial visual acuities, had a lower frequency of hypopyon, and had better visual outcomes compared to acute-onset patients. Propionibacterium acnes and coagulase-negative Staphylococcus species were the most common organisms cultured in delayed- and acute-onset categories, respectively, and were associated with the best visual acuity outcomes in each group.
Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Florida, USA. ashirodkar@med.miami.edu
Anita R
AR
Shirodkar
Avinash
A
Pathengay
Harry W
HW
Flynn
Thomas A
TA
Albini
Audina M
AM
Berrocal
Janet L
JL
Davis
Geeta A
GA
Lalwani
Timothy G
TG
Murray
William E
WE
Smiddy
Darlene
D
Miller
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001419:Bacteria / Q000302:isolation & purification; D002387:Cataract Extraction / Q000009:adverse effects*; D003131:Combined Modality Therapy; D020878:Device Removal; D009877:Endophthalmitis / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D015818:Eye Infections, Bacterial / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D015821:Eye Infections, Fungal / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D005260:Female; D005658:Fungi / Q000302:isolation & purification; D006801:Humans; D007910:Lenses, Intraocular; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D013997:Time Factors; D014792:Visual Acuity / Q000502:physiology; D014821:Vitrectomy
D000900:Anti-Bacterial Agents