Postoperative Endophthalmitis Following Cataract Surgery Over an Eight-Year Period

Jin Kim Woo; Yong Kweon Eui; Wook Lee Dong; Chun Cho Nam

doi:10.3341/jkos.2008.49.11.1771

Journal List > J Korean Ophthalmol Soc > v.49(11) > 1008130

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Woo, Eui, Dong, and Nam: Postoperative Endophthalmitis Following Cataract Surgery Over an Eight-Year Period

Original Article

J Korean Ophthalmol Soc 2008;49(11):1771-1778.

Published online: 7 September 2008

DOI: https://doi.org/10.3341/jkos.2008.49.11.1771

Postoperative Endophthalmitis Following Cataract Surgery Over an Eight-Year Period

Jin Kim Woo, M.D., Yong Kweon Eui, M.D., Wook Lee Dong, M.D., Chun Cho Nam, M.D.

Department of Ophthalmology, Chonbuk National University, School of Medicine, Jeonju, Korea

Address reprint requests to Eui Yong Kweon, M.D. Department of Ophthalmology, Chonbuk National University Medical School and Hospital #634-18 Geumam-dong, Jeonju, Chonbuk 561-712, Korea Tel: 82-63-250-2477, Fax: 82-63-250-1960, E-mail: key@chonbuk.ac.kr

Received 3 November 2008 Accepted 30 June 2008

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To estimate the annual incidence rate, evaluate any changes, analyze the microbiologic spectrum of infecting organisms, antibiotic susceptibility, and factors associated with visual outcomes of postoperative endophthalmitis following cataract surgery over an 8-year period.

Methods

A retrospective investigation of direction, sex, age, culture results, interval duration, and initial visual acuity of 29 patients with endophthalmitis following cataract surgery was conducted from January 2000 to December 2007. The study was divided into two 4-year periods, with patients categorized into either Group 1 or 2.

Results

The incidence rate was 0.359%, the major infective organism was Staphylococcus epidermidis, and no significant change was observed during the 8-year period. Vancomycin retained efficacy in all cases, but increased resistance occurred with ciprofloxacin during the 8 years. Increased visual acuity after treatment was greater in Group 2 and the interval from onset of ocular symptoms to ophthalmic consultation was shorter in Group 2, although a statistical significance was not demonstrated.

Conclusions

Vancomycin remains effective for patients with endophthalmitis following cataract surgery. Patients who initially had good visual acuity showed greater improvement. However, sex, age, or whether or not the patients had a vitrectomy operation, were not statistically significant factors in the improvement of visual acuity.

Keywords: Cataract surgery, Postoperative endophthalmitis

References

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Figure 1.

Monthly incidence of postoperative endophthalmitis following cataract surgery.^* Monthly incidence of treated patients that have postoperative endophthalmitis following cataract surgery at our hospital.

Table 1.

29 Cases of postoperative endophthalmitis following cataract surgery

	Sex/Age	Eye (OD/OS)	Culture	Duration (Days)	Initial VA (Scale)^∏	Final VA (Scale)	Surgery	Year
Our Hospital patients
1	F/76	OS	+^*	3	3	5	TPPV^§	2007.03
2	F/71	OS	+	2	3	1	TPPV	2007.03
3	M/62	OD	-^†	11	5	4	-	2001.11
4	M/70	OS	-	5	6	6	TPPV	2003.04
5	F/71	OS	ND^‡	7	3	6	-	2006.03
6	M/65	OS	ND	3	3	5	-	2006.01
7	F/74	OS	+	8	4	5	TPPV	2004.08
8	F/62	OD	+	2	5	6	-	2004.12
9	M/72	OD	+	6	6	6	-	2007.06
Transferred patients
10	M/72	OS	-	1	4	6	TPPV	2000.11
11	F/70	OD	+	3	3	1	TPPV	2007.02
12	F/70	OD	ND	3	2	3	-	2003.12
13	F/78	OS	ND	24	3	5	-	2004.12
14	F/70	OS	+	12	3	6	TPPV	2002.03
15	M/63	OD	ND	4	3	3	-	2003.12
16	F/79	OD	ND	1	5	3	TPPV	2002.02
17	M/47	OS	-	1	3	5	TPPV	2003.08
18	M/42	OD	-	1	6	6	TPPV	2000.11
19	F/76	OD	ND	20	5	5	TPPV	2000.01
20	M/47	OS	ND	90	4	6	-	2004.07
21	M/69	OD	-	9	2	3	TPPV	2004.07
22	M/71	OS	-	9	5	6	TPPV	2002.09
23	F/76	OD	ND	7	5	5	-	2002.07
24	F/69	OD	ND	5	5	3	-	2005.11
25	F/82	OD	-	4	3	6	-	2005.04
26	M/73	OS	+	2	1	1	-	2006.11
27	F/74	OD	-	2	2	1	TPPV	2007.05
28	F/72	OD	+	5	3	4	TPPV	2003.01
29	M/66	OD	-	6	3	5	TPPV	2005.01

^* +=positive

^† -=negative

^‡ ND=not done

^§ TPPV=total pars plana vitrectomy

^∏ V/A grade scale: 1=NLP; 2=LP; 3=HM~FC; 4=0.02~0.1; 5=0.1~0.4; 6=>0.4.

Table 2.

Microbiologic spectrum between two periods

	Total	Period 1	Period 2
		(2000-2003)	(2004-2007)
No growth	10	6	4
Culture (+)	9	2	7
Fungus	0	0	0
Bacterial	9	2	7
Gram positive	9	2	7
S.epidermidis	6	2	4
S.aureus	1	0	1
Enterococcus	1	0	1
S.pneumonia	1	0	1
Gram negative	0	0	0

Table 3.

Antibiotics susceptibility between two periods

	Period 1	Period 2	P value
Vancomycin
Sensitive	2	7
Resistant	0	0
Tobramycin
Sensitive	ND^*	5
Resistant	ND	2
TMP-SMX			0.625
Sensitive	1	4
Resistant	0	3
Ciprofloxacin			0.583
Senstive	1	2
Resistant	1	5
Ofloxacin
Sensitive	ND	5
Resistant	ND	2
Oxacillin			0.583
Sensitive	1	2
Resistant	1	5

^* Not done.

Table 4.

Comparison of visual acu uity prognosis & risk factors betw ween two periods

	Period 1	Period 2	P value
Initial VA			0.105
A group	5	11
B group	8	5
Final VA			0.336
A group	3	6
B group	10	10
Increased VA	10	11
Decreased VA	3	4
E group^*	3	6
F group^†	1	1
E group / Increased VA	3/10 (30%)	6/11 (60%)	0.245
F group / Decreased VA	1/3 (33.3%)	1/4 (25%)	0.714
Age	66.92	69.94
Total Patients	13	16
M:F	7:6 (1.17:1)	4:12 (1:3)	0.114
Mean Duration	5.0	4.43
Total vitrectomy	9	7	0.160
Interval (day)	6.1	12.14
Delayed onset type	1	2	0.580

^* Significantly increasing VA group

^† Significantly decreasing VA group.

Table 5.

Comparison of risk factors between two groups

	C^* Group (21)	D^† Group (8)	P-value
Mean Age	68.0	68.88
M:F	10:11 (1:1.1)	3:5 (1:1.67)	0.474
Duration	5.053	3.75	0.353
Culture positive	6	3	0.483
DM, HTN	11	4	0.617
Total vitrectomy	12	5	0.568
Interval (day)	9.91	4.50	0.259
Delayed onset type	3	0	0.379
Initial VA (>4)^‡	10	2	0.250

^* Increasing VA group

^† Decreasing or equal VA

^‡ Grade scale >4.

Table 6.

Comparison of risk factors between two groups

	E Group (9)^*	D Group (8)	P-value
Mean Age	69.67	68.88
M:F	3:6 (1:2)	3:5 (1:1.67)	0.627
Duration	5.13	3.75	0.391
Culture positive	3	3	0.627
DM, HTN	5	4	0.601
Total vitrectomy	5	5	0.581
Interval (day)	5.0	4.50	0.603
Delayed onset type	1	0	0.529
Initial VA (>3)^†	9	6	0.206

^* Significantly increasing VA group

^† V/A grade scale >3.

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