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Comparative Study
, 153 (3), 391-398.e2

Delayed- Versus Acute-Onset Endophthalmitis After Cataract Surgery

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Comparative Study

Delayed- Versus Acute-Onset Endophthalmitis After Cataract Surgery

Anita R Shirodkar et al. Am J Ophthalmol.

Abstract

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

Design: 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.

Figures

Figure 1
Figure 1
Hypopyon and granulomatous keratic precipitates associated with Propionibacterium acnes endophthalmitis. Upper. Initial presentation of patient #2; visual acuity 5/200. Lower. After pars plana vitrectomy with total capsulectomy and IOL removal; visual acuity was 20/20 with aphakic contact lens correction.
Figure 1
Figure 1
Hypopyon and granulomatous keratic precipitates associated with Propionibacterium acnes endophthalmitis. Upper. Initial presentation of patient #2; visual acuity 5/200. Lower. After pars plana vitrectomy with total capsulectomy and IOL removal; visual acuity was 20/20 with aphakic contact lens correction.
Figure 2
Figure 2
White plaque within the capsular bag associated with Propionibacterium acnes endophthalmitis. Upper. Initial presentation of patient #22; visual acuity was 20/40. Lower. After pars plana vitrectomy with partial capsulectomy; visual acuity was 20/25.
Figure 2
Figure 2
White plaque within the capsular bag associated with Propionibacterium acnes endophthalmitis. Upper. Initial presentation of patient #22; visual acuity was 20/40. Lower. After pars plana vitrectomy with partial capsulectomy; visual acuity was 20/25.
Figure 3
Figure 3
White plaque within the capsular bag associated with Acremonium strictum endophthalmitis. Upper. Initial presentation of patient #12; visual acuity was 20/200. Middle. Recurrence of infection with hypopyon after pars plana vitrectomy; visual acuity was hand motions. Lower. After pars plana vitrectomy with total capsulectomy and IOL removal; visual acuity was 20/30 with aphakic contact lens correction.
Figure 3
Figure 3
White plaque within the capsular bag associated with Acremonium strictum endophthalmitis. Upper. Initial presentation of patient #12; visual acuity was 20/200. Middle. Recurrence of infection with hypopyon after pars plana vitrectomy; visual acuity was hand motions. Lower. After pars plana vitrectomy with total capsulectomy and IOL removal; visual acuity was 20/30 with aphakic contact lens correction.
Figure 3
Figure 3
White plaque within the capsular bag associated with Acremonium strictum endophthalmitis. Upper. Initial presentation of patient #12; visual acuity was 20/200. Middle. Recurrence of infection with hypopyon after pars plana vitrectomy; visual acuity was hand motions. Lower. After pars plana vitrectomy with total capsulectomy and IOL removal; visual acuity was 20/30 with aphakic contact lens correction.
Figure 4
Figure 4
Surgical procedures in delayed-onset endophthalmitis patients who had intraocular lens implant (IOL) removal*. *Of the 7 patients with delayed-onset endophthalmitis who did not undergo IOL removal, initial treatment was PPV/PC/IOAB (4 patients), PPV/IOAB (2 patients), and IOAB (1 patient). No patients had recurrences or further interventions. Abbreviations: IOAB = intraocular antibiotics; PPV = pars plana vitrectomy; PC = partial capsulectomy; TC = total capsulectomy; noIOL = IOL removal; PKP = penetrating keratoplasty; IOLx = IOL exchange.

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