[Follow-up of postoperative endophthalmitis after cataract surgery and intravitreal injection of drugs - an analysis since 2009].
BACKGROUND
The frequency of intravitreal injection of drugs (IVI) has significantly increased recently and it is performed like cataract surgery as an outpatient procedure. The occurrence of postoperative endophthalmitis is rare, only few data of multicentre studies are available.


METHODS
We analysed the data of 30 consecutive patients with endophthalmitis following cataract surgery (group 1, n = 20) and IVI (group 2, n = 10) requiring therapy in a referral eye clinic from January 2009 to December 2013. All patients received topical and systemic anti-inflammatory and anti-infective therapy. Due to vitreous opacification and severe loss of vision 83 % of the eyes underwent immediately pars plana vitrectomy with diagnostic microbiological probe and intravitreal application of vancomycin and gentamicin.


RESULTS
Endophthalmitis occurred independently in both groups 1 to 10 days, on average 4 days, postoperatively. Group 1 showed conjunctival infection in 80 % (n = 16), group 2 in 20 % (n = 2). Hypopyon was found in group 1 in 65 % (n = 13), in group 2 in 40 % (n = 4). Group 1 presented retinal haemorrhages and epiretinal fibrin membranes in 15 % (n = 3), group 2 in 70 % (n = 7). Vitreous cultures were positive in 80 % (vancomycin-sensitive staphylococci). Staphylococcus was the most frequent bacteria, resistant to ceftazidime. In group 1 visual acuity was initially in 65 % (n = 13) of the eyes < 20/400 or worse, in group 2 90 % (n = 9) of the eyes had hand motions and in 10 % (n = 1) worse than 20/400. Visual outcome was 20/30 on average for group 1, PVR retinal detachment occurred once. In group 2 no patient achieved better visual outcome than < 20/400, 40 % of the eyes required permanent silicon oil tamponade because of PVR retinal detachment. The major pathogens were staphylococci resistant to ceftazidim.


CONCLUSIONS
Endophthalmitis following IVI had poor visual outcome compared to endophthalmitis following cataract surgery and showed less anterior segment symptoms.
Klinik für Augenheilkunde, Vivantes Klinikum Neukölln, Berlin.
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Michel
Klinik für Augenheilkunde, Vivantes Klinikum Neukölln, Berlin.
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H
Häberle
Klinik für Augenheilkunde, Vivantes Klinikum Neukölln, Berlin.
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DT
Pham
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000556:Ambulatory Surgical Procedures; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000068258:Bevacizumab / Q000008:administration & dosage / Q000009:adverse effects; D002387:Cataract Extraction; D004352:Drug Resistance, Microbial; D009877:Endophthalmitis / Q000209:etiology* / Q000628:therapy; D005839:Gentamicins / Q000627:therapeutic use; D006801:Humans; D058449:Intravitreal Injections / Q000009:adverse effects*; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology* / Q000628:therapy; D000069579:Ranibizumab / Q000008:administration & dosage / Q000009:adverse effects; D012163:Retinal Detachment / Q000209:etiology / Q000628:therapy; D012189:Retrospective Studies; D012827:Silicone Oils / Q000008:administration & dosage; D013203:Staphylococcal Infections / Q000209:etiology* / Q000628:therapy; D014640:Vancomycin / Q000627:therapeutic use; D014792:Visual Acuity; D014821:Vitrectomy
D000893:Anti-Inflammatory Agents; D005839:Gentamicins; D012827:Silicone Oils; D000068258:Bevacizumab; D014640:Vancomycin; D000069579:Ranibizumab