Risk Factors Leading to Enucleation or Evisceration in Endophthalmitis

Jung Yeul Kim; Seon Jin Wang; Chang Jun Park; Sung Bok Lee

doi:10.3341/jkos.2007.48.10.1362

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Kim, Wang, Park, and Lee: Risk Factors Leading to Enucleation or Evisceration in Endophthalmitis

Original Article

J Korean Ophthalmol Soc 2007;48(10):1362-1368.

Published online: 30 August 2007

DOI: https://doi.org/10.3341/jkos.2007.48.10.1362

Risk Factors Leading to Enucleation or Evisceration in Endophthalmitis

Jung Yeul Kim, M.D.^1,², Seon Jin Wang, M.D.¹, Chang Jun Park, M.D.¹, Sung Bok Lee, M.D.^1,²

¹Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon, Korea

²Research Institute for Medical Science, Daejeon, Korea

Address reprint requests to Sung Bok Lee, M.D., Department of Ophthalmology, Chungnam National University Hospital, #640 Daesa-dong, Jung-gu, Daejeon 301-721, Korea, Tel: 82-42-280-7608, Fax: 82-42-255-3745, E-mail: sblee@cnu.ac.kr

Received 31 January 2007 Accepted 27 June 2007

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 evaluate the risk factors associated with enucleation or evisceration in endophthalmitis patients.

Methods

The medical records of endophthalmitis cases from January 1995 to July 2006 were reviewed retrospectively. The cases were divided into 2 groups, the enucleation/evisceration group (36 eyes of 36 patients) who underwent enucleation or evisceration and the intraocular procedures group (61 eyes of 60 patients) who received intravitreal antibiotics injection and/or vitrectomy. We analyzed these cases with respect to age, sex, initial visual acuity, causes of endophthalmitis, systemic disease, and causative organisms.

Results

Older age (p=0.002), women (17/32, p=0.027), no light perception at presentation (33/37, p<0.001), endophthalmitis associated with corneal ulcer (25/25, p<0.001), and diabetes mellitus (14/20, p=0.001) were significantly associated with enucleation or evisceration.

Conclusions

Older age, poor initial visual acuity, endophthalmitis associated with corneal ulcer, and diabetes mellitus were strongly associated with enucleation or evisceration. If any of these factors are present, more intensive treatments are warranted to prevent loss of the eye.

Keywords: Diabetes mellitus, Endophthalmitis, Enucleation, Evisceration

References

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Table 1.

Characteristics of the study population

	Enucleation/Evisceration group	Intraocular procedures group	Total	p-value
Number of patients (eyes)	36	61	97
Age (years)	66.1± 12.6	54.6±19.1		0.002^*
Sex
Male	19 (29.2%)	46 (70.8%)	65	0.027^†
Female	17 (53.1%)	15 (46.9%)	32

^∗ t-test.

^† Chi-square test.

Table 2.

Comparison of treatment modalities according to initial visual acuity

Visual acuity	Enucleation/Evisceration group	Intraocular procedures group	Total	p-value
NLP	33 (89.2%)	4 (10.8%)	37
LP, HM, FC	3 (5.5%)	52 (94.5%)	55	<0.001^*
≥ 0.02	0 (0.0%)	5 (100.0%)	5

NLP=no light perception; LP=light perception; HM=hand motion; FC=finger counting.

^∗ Chi-square test.

Table 3.

Comparison of treatment modalities according to causes of endophthalmitis

Causes	Enucleation/Evisceration group	Intraocular procedures group	Total	p-value
Intraocular surgery	1 (2.8%)	35 (97.2%)	36	<0.001^*
Corneal ulcer	25 (100.0%)	0 (0.0%)	25	<0.001^*
Trauma	2 (9.1%)	20 (90.9%)	22	0.002^*
Endogenous	3 (33.3%)	6 (66.7%)	9	0.80^†
Unknown	5 (100.0%)	0 (0.0%)	5	<0.001^†

^∗ Chi-square test,

^† Fisher's exact test. All statistical analyses are performed independently according to the causes of endophthalmitis.

Table 4.

Comparison of treatment modalities according to systemic diseases : diabetes mellitus, hypertension

	Enucleation /Evisceration group	Intraocular procedures group	Total	p-value^∗
Diabetes mellitus (+)	14 (70.0%)	6 (30.0%)	20	0.001
(-)	22 (28.6%)	55 (71.4%)	77	0.001
Hypertension (+)	9 (50.0%)	9 (50.0%)	18	0.212
(-)	27 (34.2%)	52 (65.8%)	79	0.212

^* Chi-square test.

Table 5.

Comparison of treatment modalities according to causative organisms

Organisms	Enucleation/Evisceration group	Intraocular procedures group	Total
G (-) aerobes	6	8	14
Pseudomonas aeruginosa	5	2	7
Streptococcus	-	4	4
Branhamella catarrhalis	1	-	1
Alcaligenes xylosoxidans	-	2	2
G (-) anaerobes	4	4	8
Serratia marcescens	1	-	1
Klebsiella pneumoniae	3	2	5
Enterobacter sakazakii	-	2	2
G (+) anaerobes	6	8	14
Arcanobacterium haemolyticum	0	1	1
Staphylococcus epidermidis	3	3	6
Staphylococcus aureus	1	1	2
Staphylococcus hemolyticus	1	1	2
Warneri	-	1	1
Enterococcus	1	1	2
Fungus Aspergillus	1	-	1
No growth	9	18	27
Total	26	38	64^*

^∗ The cultivation of bacteria was conducted in 64 eyes out of 97.

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