To portray the current scene of endophthalmitis in a multispecialty ophthalmology department regarding etiologies and treatment guidelines.
Methods
Retrospective chart review of all patients diagnosed with endophthalmitis or suspected endophthalmitis from 2009 to 2012.
Results
A total of 24 eyes were diagnosed with endophthalmitis or suspected endophthalmitis during a 4-year period. The etiologies included endogenous endophthalmitis (6), blebitis (3), Ahmed valve implantation (3, 2 of them with late infection), postcataract surgery (3), intravitreal injections (4), penetrating injury (2), and other surgical procedures (3). Of the postcataract surgery cases, 1 was a congenital cataract surgery, and 2 were referrals. There were no endophthalmitis cases in 4603 adults undergoing cataract surgery in our department during this period. There were 14 positive cultures: 1 was candida and the rest bacteria. Ten of the bacteria cases were Gram-positive cocci (predominantly strep species), 3 were Gram-negative, and coagulase negative staphylococci were detected in 2 cases.
Conclusions
Our study indicates a significant change in the case mix of endophthalmitis. The past leading cause, cataract surgery, was dramatically reduced, and intravitreal injections became a major cause. The change in etiologies, and possibly in the microbial flora, warrants reconsideration of the rules that guided the management of endophthalmitis since the Endophthalmitis Vitrectomy Study.
KaracalHKymesSMApteRSRetrospective analysis of etiopathogenesis of all cases of endophthalmitis at a large tertiary referral center. Int Ophthalmol200727251–9.
2.
KessnerRGolanSBarakAChanges in the etiology of endophthalmitis from 2003 to 2010 in a large tertiary medical center. Eur J Ophthalmol201424918–24.
3.
Endophthalmitis Study Group, European Society of Cataract & Refractive Surgeons. Prophylaxis of postoperative endophthalmitis following cataract surgery: results of the ESCRS multicenter study and identification of risk factors. J Cataract Refract Surg200733978–88.
4.
MontanPGWejdeGKoranyiGRylanderMProphylactic intracameral cefuroxime. Efficacy in preventing endophthalmitis after cataract surgery. J Cataract Refract Surg200228977–81.
5.
VaziraniJBasuSRole of topical, subconjunctival, intracameral, and irrigative antibiotics in cataract surgery. Curr Opin Ophthalmol20132460–5.
6.
BrownDMKaiserPKMichelsM; ANCHOR Study Group. Ranibizumab versus verteporfin for neovascular age-related macular degeneration. N Engl J Med20063551432–44.
7.
RosenfeldPJBrownDMHeierJS; MARINA Study Group. Ranibizumab for neovascular age-related macular degeneration. N Engl J Med20063551419–31.
8.
TabandehHBosciaFSborgiaAEndophthalmitis associated with intravitreal injections: office-based setting and operating room setting. Retina20143418–23.
9.
HolladayJTProper method for calculating average visual acuity. J Refract Surg199713388–91.
10.
Schulze-BonselKFeltgenNBurauHHansenLBachMVisual acuities “hand motion” and “counting fingers” can be quantified with the Freiburg visual acuity test. Invest Ophthalmol Vis Sci2006471236–40.
11.
ShorsteinNHWinthropKLHerrintonLJDecreased postoperative endophthalmitis rate after institution of intracameral antibiotics in a Northern California eye department. J Cataract Refract Surg2013398–14.
12.
RudniskyCJWanDWeisEAntibiotic choice for the prophylaxis of post-cataract extraction endophthalmitis. Ophthalmology2014121835–41.
13.
TabanMBehrensANewcombRLAcute endophthalmitis following cataract surgery: a systematic review of the literature. Arch Ophthalmol2005123613–20.
14.
KeayLGowerEWCassardSDTielschJMScheinODPostcataract surgery endophthalmitis in the United States: analysis of the complete 2003 to 2004 Medicare database of cataract surgeries. Ophthalmology2012119914–22.
15.
LemleyCAHanDPEndophthalmitis: a review of current evaluation and management [erratum. 2007; 27: table of contents]. Retina200727662–80.
16.
WheelerDTStagerDRWeakleyDRJrEndophthalmitis following pediatric intraocular surgery for congenital cataracts and congenital glaucoma. J Pediatr Ophthalmol Strabismus199229139–41.
17.
DaveHPhoenixVBeckerERLambertSRSimultaneous vs sequential bilateral cataract surgery for infants with congenital cataracts: visual outcomes, adverse events, and economic costs. Arch Ophthalmol20101281050–4.
18.
KushnerBJSimultaneous cataract surgery for bilateral congenital cataracts: are the cost savings worth the risk?Arch Ophthalmol20101281073–4.
19.
GoodWVHingSIrvineARHoytCSTaylorDSPostoperative endophthalmitis in children following cataract surgery. J Pediatr Ophthalmol Strabismus199027283–5.
20.
WuZHChanRPLukFOReview of clinical features, microbiological spectrum, and treatment outcomes of endogenous endophthalmitis over an 8-year period. J Ophthalmol20122012265078.
21.
ShahCPGargSJVanderJFBrownGCKaiserRSHallerJAPost-Injection Endophthalmitis (PIE) Study Team. Outcomes and risk factors associated with endophthalmitis after intravitreal injection of anti-vascular endothelial growth factor agents. Ophthalmology20111182028–34.
22.
LyallDAMTeyAFootBPost-intravitreal anti-VEGF endophthalmitis in the United Kingdom: incidence, features, risk factors, and outcomes. Eye2012261517–26.
23.
StoreyPDollinMPitcherJ; Post-Injection Endophthalmitis Study Team. The role of topical antibiotic prophylaxis to prevent endophthalmitis after intravitreal injection. Ophthalmology2014121283–9.
24.
CheungCSYWongAWTLuiAKertesPJDevenyiRGLamW-CIncidence of endophthalmitis and use of antibiotic prophylaxis after intravitreal injections. Ophthalmology20121191609–14.
25.
AveryRLBakriSJBlumenkranzMSIntravitreal injection technique and monitoring: updated guidelines of an expert panel. Retina201434Suppl 12S1–S18.
26.
MatthewsJLDubovySRGoldbergRAFlynnHWJrHistopathology of streptococcus mitis/oralis endophthalmitis after intravitreal injection with bevacizumab: a report of 7 patients. Ophthalmology2014121702–8.
27.
PakravanMYazdaniSShahabiCYaseriMSuperior versus inferior Ahmed glaucoma valve implantation. Ophthalmology2009116208–13.
28.
Al-TorbakAAAl-ShahwanSAl-JadaanIAl-HommadiAEdwardDPEndophthalmitis associated with the Ahmed glaucoma valve implant. Br J Ophthalmol200589454–8.
29.
AngGSVargaZShaarawyTPostoperative infection in penetrating versus non-penetrating glaucoma surgery. Br J Ophthalmol2010941571–6.
30.
AhmedYSchimelAMPathengayAColyerMHFlynnHWJrEndophthalmitis following open-globe injuries. Eye201226212–7.
ColyerMHWeberEDWeichelEDDelayed intraocular foreign body removal without endophthalmitis during Operations Iraqi Freedom and Enduring Freedom. Ophthalmology20071141439–47.
33.
RecchiaFMBaumalCRSivalingamAKleinerRDukerJSVrabecTREndophthalmitis after pediatric strabismus surgery. Arch Ophthalmol2000118939–44.
34.
SimonJWLiningerLLScheragaJLRecognized scleral perforation during eye muscle surgery: incidence and sequelae. J Pediatr Ophthalmol Strabismus199229273–5.
35.
HanDPWisniewskiSRWilsonLASpectrum and susceptibilities of microbiologic isolates in the Endophthalmitis Vitrectomy Study. Am J Ophthalmol19961221–17.
36.
Endophthalmitis Vitrectomy Study Group. Results of the Endophthalmitis Vitrectomy Study. A randomized trial of immediate vitrectomy and of intravenous antibiotics for the treatment of postoperative bacterial endophthalmitis. Arch Ophthalmol19951131479–96.
