Factors Associated with a Poor Visual Result in Acute Endophthalmitis After Cataract Surgery

Ja Young Jung; Byung Yi Ko; Byeoung Yeob Kim

doi:10.3341/jkos.2008.49.8.1242

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Jung, Ko, and Kim: Factors Associated with a Poor Visual Result in Acute Endophthalmitis After Cataract Surgery

Original Article

J Korean Ophthalmol Soc 2008;49(8):1242-1247.

Published online: 7 September 2008

DOI: https://doi.org/10.3341/jkos.2008.49.8.1242

Factors Associated with a Poor Visual Result in Acute Endophthalmitis After Cataract Surgery

Ja Young Jung, M.D.¹, Byung Yi Ko, M.D.², Byeoung Yeob Kim, M.D.¹

Department of Ophthalmology, Konyang University, Kim’s Eye Hospital, Myung-Gok Eye Research Institute, Seoul, Korea

Department of Ophthalmology, Collage of Medicine, Konyang University, Daejeon, Korea

Address reprint requests to Byeoung Yeob Kim, M.D. Department of Ophthalmology, Kim's Eye Hospital #156 4ga, Yeoungdungpo-dong, Yeoungdungpo-gu, Seoul, Korea Tel: 82-2-2639-7777, Fax: 82-2-2639-7766, E-mail: yeopk@konyang.ac.kr

Received 6 May 2008 Accepted 26 July 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 determine the factors related to the clinical outcome of acute endophthalmitis after cataract surgery.

Methods

Authors performed a retrospective study of 65 eyes of 65 patients who had been treated for endophthalmitis from 2001 to 2006 at our hospital. We analyzed the relationship between final visual outcomes and prognostic factors.

Results

Final visual acuities were 0.5 or better in 49.2% of all eyes. Of 57 eyes, 29 eyes (50.8%) were culture positive. Staphylococcus epidermidis and Streptococcus pneumoniae were the most common organisms isolated. Cases with baseline acuity of counting fingers or better, cases with culture-negative or gram-positive infection, and cases not requiring vitrectomy had better prognoses.

Conclusions

Baseline visual acuity, type of cultured organism, and method of treatment are significantly related to visual prognosis.

Keywords: Acute endophthalmitis, Cataract surgery

References

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Table 1.

Baseline demographic and clinical characteristics (n=65)

	n (%)
Gender (male/female)	30 (46.2%) / 35 (53.8%)
In-House/Referred	19 (29.2%) / 46 (70.8%)
Age (yrs)
mean	65.28±12.34
<65 yr	23 (35.4%)
≥65 yr	42 (64.6%)
Type of surgery
ECCE*+PCL^†	11 (16.9%)
PE^‡+PCL	54 (83.1%)
Side
Right / Left	29 (44.6%) / 36 (55.4%)
Follow up (months)
mean	6.08±5.71
Diabetes
(+)	13 (20%)
(-) Initial vision	52 (80%)
≥ 0.1	14 (21.6%)
< 0.1 Final vision	51 (78.4%)
≥ 0.1	40 (77%)
< 0.1	25 (23%)

^* ECCE=extracapsular cataract extraction; chamber intraocular lens;

^‡ PE=phacoemulsification.

^† PCL=posterior

Table 2.

Diabetes mellitus and final visual acuity

	Final visual acuity
	20/200 to 20/20	Worse than 20/200	total	p-value*
DM (+)	10	3	13	0.339
DM (-)	30	22	52

^* Pearson chi-square test.

Table 3.

Causative organisms

Organism			No. of eyes
No exam			8
Culture negative			28
Culture positive	Gram positive	Staphylococcus epidermidis	8
		Streptococcus sp	8
	Gram negative	Enterobacter sp	5
		Pseudomonas aeruginosa	5
	Fungus		3

Table 4.

Causative organisms and final visual acuity

	Final visual acuity
	20/200 to 20/20	Worse than 20/200	Total	p-value*
No growth & gram positive	30	14	44
Gram negative & fungus	4	9	13	0.024

^* Pearson chi-square test.

Table 5.

Initial visual acuity and final visual acuity

	Final visual acuity
	20/200 to 20/20	Worse than 20/200	n Total	p-value*
20/20-20/40	2	0	2
20/50-20/200	11	1	12
FC	10	2	12	0.003
HM	15	15	30
NLP & LP	2	7	9

^* Fisher’s exact test.

Table 6.

Onset of symptom after cataract surgery and final visual acuity

	Final visual acuity
	20/200 to 20/20	Worse than 20/200	Total	p-value*
Within 7 days After 8 days	28 12	17 8	45 20	0.865

^* Pearson chi-square test.

Table 7.

Time to treatment and final visual acuity

	Final visual acuity
Time to treatment	20/200 to 20/20	Worse than 20/200	Total	p-value*
Within 2 days After 3 days	35 5	19 6	54 11	0.311

^* Pearson chi-square test.

Table 8.

Treatment method and final visual acuity

	Final visual acuity
	20/200 to 20/20	Worse than 20/200	n Total	p-value*
Conservative treatment	4	0	4
Only IVAI^†	21	6	27	0.007
Vitrectomy with IVAI^†	15	19	34

^* Fisher’s exact test

^† IVAI=intravitreal antibiotics injection.

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