Delayed- Versus Acute-Onset Endophthalmitis After Cataract Surgery

Am J Ophthalmol. 2012 Mar;153(3):391-398.e2. doi: 10.1016/j.ajo.2011.08.029. Epub 2011 Oct 25.

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.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease
  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents / therapeutic use
  • Bacteria / isolation & purification
  • Cataract Extraction / adverse effects*
  • Combined Modality Therapy
  • Device Removal
  • Endophthalmitis / diagnosis
  • Endophthalmitis / microbiology*
  • Endophthalmitis / therapy
  • Eye Infections, Bacterial / diagnosis
  • Eye Infections, Bacterial / microbiology*
  • Eye Infections, Bacterial / therapy
  • Eye Infections, Fungal / diagnosis
  • Eye Infections, Fungal / microbiology*
  • Eye Infections, Fungal / therapy
  • Female
  • Fungi / isolation & purification
  • Humans
  • Lenses, Intraocular
  • Male
  • Middle Aged
  • Postoperative Complications*
  • Retrospective Studies
  • Time Factors
  • Visual Acuity / physiology
  • Vitrectomy

Substances

  • Anti-Bacterial Agents