Endophthalmitis After Clear Corneal Cataract Surgery: Outcomes Over Two Decades

Abstract Purpose To report the clinical features, causative organisms, and visual acuity (VA) outcomes associated with acute-onset endophthalmitis after clear corneal cataract surgery over the past two decades. Design Retrospective case series. Methods Clinical and microbiology records were reviewed...

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Bibliographic Details
Published in:American journal of ophthalmology 2017-02, Vol.174, p.155-159
Main Authors: Yannuzzi, Nicolas A., MD, Si, Nancy, BS, Relhan, Nidhi, MD, Kuriyan, Ajay E., MD, Albini, Thomas A., MD, Berrocal, Audina M., MD, Davis, Janet L., MD, Smiddy, William E., MD, Townsend, Justin, MD, Miller, Darlene, CIC, DHSc, Flynn, Harry W., MD
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Anti-Bacterial Agents - therapeutic use
Antibiotics
Cataract Extraction - adverse effects
Cataract Extraction - methods
Cataracts
Cornea - diagnostic imaging
Cornea - surgery
Endophthalmitis - diagnosis
Endophthalmitis - drug therapy
Endophthalmitis - etiology
Eye Infections, Bacterial - diagnosis
Eye Infections, Bacterial - drug therapy
Eye Infections, Bacterial - etiology
Eye surgery
Female
Follow-Up Studies
Humans
Laboratories
Light
Male
Middle Aged
Ophthalmology
Organisms
Retrospective Studies
Sheep
Staphylococcal Infections - diagnosis
Staphylococcal Infections - drug therapy
Staphylococcal Infections - etiology
Staphylococcus - isolation & purification
Surgical Wound Infection - diagnosis
Surgical Wound Infection - drug therapy
Surgical Wound Infection - etiology
Time Factors
Visual Acuity
Vitreous Body - microbiology
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Summary:Abstract Purpose To report the clinical features, causative organisms, and visual acuity (VA) outcomes associated with acute-onset endophthalmitis after clear corneal cataract surgery over the past two decades. Design Retrospective case series. Methods Clinical and microbiology records were reviewed for 63 eyes of 63 patients who presented to a tertiary referral center between 2006 and 2015 with culture-positive endophthalmitis occurring within 6 weeks of clear corneal cataract surgery. Results The mean time between surgery and diagnosis of endophthalmitis was 8 days (median 6 days). The initial treatment included intravitreal vancomycin and ceftazidime in 59 of 63 (94%) eyes and intravitreal vancomycin and amikacin in 4 of 63 (6%) eyes. Intravitreal dexamethasone was used in 50 of 63 (79%) eyes. A vitreous tap and injection with antibiotics was performed as the initial treatment in 57 of 63 (90%) eyes and pars plana vitrectomy in 6 of 63 (10%) eyes. Coagulase-negative Staphylococcus was isolated in 39 of 63 (62%) eyes, Staphylococcus aureus in 7 of 63 (11%) eyes, and Streptococcus species in 7 of 63 (11%) eyes. A VA of ≥20/40 was achieved in 24 of 63 (38%) eyes. None of the gram-positive isolates were vancomycin resistant. Twenty-four of 49 isolates (49%) were sensitive to cephalothin, cefazolin, and cefuroxime. Sensitivity to fluoroquinolones included 22/52 (42%) to levofloxacin, 20/54 (37%) to ciprofloxacin, 16/47 (34%) to moxifloxacin, and 3/13 (23%) to gatifloxacin. Conclusion Causative organisms and visual outcomes are similar to those reported in the prior decade. In the current study, a number of isolates were resistant to cephalosporins and fluoroquinolones.
ISSN:0002-9394
1879-1891
DOI:10.1016/j.ajo.2016.11.006