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Choi, Kim, Han, Lee, Cho, Lee, Kim, and Kim: Analysis of Referred 113 Patients with Endophthalmitis after Cataract Surgery and Associated Prognostic Factors
Original Article

J Korean Ophthalmol Soc 2016;57(3):420-428.

Published online: 3 September 2016

DOI: https://doi.org/10.3341/jkos.2016.57.3.420

Analysis of Referred 113 Patients with Endophthalmitis after Cataract Surgery and Associated Prognostic Factors

Seong Chan Choi, MD, Hyoung Seok Kim, MD, Jung Il Han, MD, Dong Won Lee, MD, Sung Won Cho, MD, Tae Gon Lee, MD, Chul Gu Kim, MD, Jong Woo Kim, MD

Myunggok Eye Research Institute, Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea

Address reprint requests to Han Joo Cho, MD Department of Ophthalmology, Kim's Eye Hospital, #136 Yeongsin-ro, Yeongdeungpo-gu, Seoul 07301, Korea, Tel: 82-2-1577-2639, Fax: 82-2-2671-6359, E-mail: chojoo@kimeye.com

Received 10 July 2015       Revised 11 September 2015       Accepted 20 November 2015

Copyright © 2016 The Korean Ophthalmological Society

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 factors affecting final visual acuity by analyzing patients referred with infectious endophthalmitis after cataract surgery.

Methods

A retrospective investigation of clinical notes of 113 patients referred with endophthalmitis following cataract surgery was conducted from January 2008 to December 2013. To evaluate factors affecting final visual acuity, initial visual acuity, onset of endophthalmitis after the cataract surgery, types of treatment, presence of hypopyon and culture results were investigated.

Results

Of the 113 patients, visual acuities at presentation were hand motions or less in 75 patients (66.3%) and final visual acuities after treatments were 0.5 or better in 73 patients (64.6%). Cases with initial visual acuity of hand motions or better achieved favorable outcomes whereas cases with gram-negative infection or endophthalmitis occurring within 2 days postoperatively showed poor prognosis. Statistically, vitrectomy versus intraocular antibiotic injection as primary means of treatment showed no differences in final visual acuity in patients with initial visual acuity of hand motion or better.

Conclusions

Visual acuities at presentation, type of cultured organism and onset of endophthalmitis after cataract surgery are significantly related to visual prognosis. Advantages of initial vitrectomy versus intraocular antibiotic injections were unclear and further investigations are necessary to clarify these issues.

Keywords: Cataract surgery, Postoperative endophthalmitis, Prognostic factors, Visual acuity

References

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Figure 1.
Seasonal distribution of endophthalmitis after cataract surgery. The most likely month for patients to develop endophthalmitis was March.
jkos-57-420f1.tif
Table 1.
Summary of baseline patient characteristics
Characteristic Number (%) Mean ± SD (range)
Age (years) 70.3 ± 9.4 (41-96)
Gender
 Male 49 (43.4)
 Female 64 (56.6)
Involved eye
 Right 54 (47.8)
 Left 59 (52.2)
Presenting visual acuity
 LP or less 17 (15.0)
 HM 58 (51.3)
 FC (<20/400) 23 (20.4)
 ≥20/800 15 (13.3)
Mean follow up period (months) 15.5 ± 14.2 (2-76)
Time from surgery to presentation
 1-7 days 71 (62.8)
 >7 days 42 (37.2)
Type of ocular surgery
 Phacoemulsification 108 (95.6)
 ECCE or ICCE 5 (4.4)
Number of patients who received 30/113
 treatments before referral (26.5)
Posterior capsule status
 Intact 107 (94.7)
 Ruptured 6 (5.3)
Intraocular pressure 14.5 ± 6.5 (6-37)
Total 113

Values are presented as mean ± SD unless otherwise indicated. LP= light perception; HM= hand motions; FC= finger counts; ECCE= extracapsular cataract extraction; ICCE = intracapsular cataract extraction.

Table 2.
Type of treatments received before referral
Treatments Total count
IOAI only 23
IOAI with A/C irrigation 2
A/C irrigation 4
Primary vitrectomy 1
Total 30

IOAI = intraocular antibiotic injection; A/C = anterior chamber.

Table 3.
Microbiologic spectrum
Bacterial and fungal culture Total count
Gram-positive bacteria
 Staphylococcus epidermidis 23
 MRSE 1
 Streptococcus sanguinis 4
 Streptococcus mitis 2
 Enterococcus faecalis 10
Gram-negative bacteria
 Pseudomonas aeruginosa 14
 Acinetobacter baumannii 4
 Serratia marcescens 2
 Stenotrophomonas maltophilia 4
Total 63

MRSE = Methicillin-resistant Staphylococcus epidermidis.

Table 4.
Type of initial intervention according to presenting visual acuity
Presenting vision Initial intervention
 Total
PPV + IOAI IOAI
LP 17 0 17
HM 36 22 58
Better than HM 15 23 38
Total 64 49 113

PPV = pars plana vitrectomy; IOAI = intraocular antibiotic injection, LP = light perception; HM = hand motions.

Table 5.
Comparison of final visual acuity after different types of treatments
Total count Final VA ≥ 0.50
 p-value
n %
All cases 113 0.184*
 Primary vitrectomy 68 40 58.8
 Primary IOAI ± additional PPV 45 32 71.1
Cases with presenting VA of HM 58 0.985*
 Primary vitrectomy 36 23 63.8
 Primary IOAI ± additional PPV 22 14 63.6
Cases with presenting VA of FC 23 0.178†
 Primary vitrectomy 9 8 88.9
 Primary IOAI ± additional PPV 14 9 63.6
Cases with presenting VA ≥ HM 96 0.876*
 Primary vitrectomy 51 37 72.5
 Primary IOAI ± additional PPV 45 32 71.1

VA = visual acuity; IOAI = intraocular antibiotics injection; PPV = pars plana vitrectomy; HM = hand motions; FC= finger counts.

* Pearson Chi-Square test;

† Fisher's exact test.

Table 6.
Factors associated with visual outcome
Factor Final visual acuity
 Significance of association (p-value)
Bettern than 20/200 (%) Worse than 20/200 (%)
Age (years) 0.244*
 Median (range) 70 (44-89) 70 (41-96)
Gender 0.057†
 Male 34 (39.1) 15 (57.7)
 Female 53 (60.9) 11 (42.3)
Involved eye 0.981†
 Right 42 (48.3) 12 (46.2)
 Left 45 (51.7) 14 (53.8)
Latency period 0.043†
 <3 days 34 (39.1) 16 (61.5)
 ≥3 days 53 (60.9) 10 (38.5)
Time to presentation 0.172‡
 <7 days 79 (90.8) 21 (80.8)
 ≥7 days 8 (9.2) 5 (19.2)
Presenting visual acuity 0.001†
 Light perception or less 7 (8.0) 10 (38.5)
 Hand motions or better 80 (92.0) 16 (61.5)
Hypopyon 0.565†
 Yes 49 (56.3) 16 (61.5)
 No 38 (43.7) 10 (38.5)
Causative organism 0.030§
 Negative growth 42 (48.3) 8 (30.8)
 Gram-positive 31 (35.6) 8 (30.8)
 Gram-negative 14 (16.1) 10 (38.4)
Immediate vitrectomy 0.140†
 Yes 46 (52.9) 18 (69.2)
 No 41 (47.1) 8 (30.8)

* Data expressed as median and range, and compared by Mann-Whitney's test;

† Data expressed as count and percentage, and tested by the Chi-square test;

‡ Data expressed as count and percentage, and tested by the Fisher's exact test;

§ Data expressed as count and percentage, and tested by the linear by linear association.

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