K 414
Postoperative results after vitrectomy for exogenous endophthalmitis at the Charité Eye Hospital in 1988-1999
K.-H. Velhagen, S. Kaduk, H. Baatz
Introduction: In a retrospective study, we analyzed patient records from 19881999. Postoperative results from 94 patients with exogenous endophthalmitis which received a pars-plana vitrectomy were studied.
Materials and methods: The patient records were analyzed for the following parameters: type of primary surgery, duration until the first inflammatory symptoms occured, time period between diagnosis and vitrectomy, infectious agent, systemic disease, effect of lens explantation, weekday of referral and pre- and postoperative visual acuity. Indication for vitrectomy was the loss of red glow or sonographic evidence of vitreous infiltration or reduced visual acuity below 1/24. Surgery was performed by two surgeons. All vitrectomies were performed by a pars plana approach. Vitreous specimens were collected before vitrectomy. After attempted complete vitrectomy, 5 µg of gentamicin were injected into the vitreous cavity.
Results: The majority of patients (29) presented 3-4 days after primary surgery. The type of primary surgery was ECCE in 47 patients, phacoemulsification in 29 patients and secondary lens implantation in two cases. Half of the cases were not referred to us on the day of the diagnosis. The preoperative visual acuity in 96% of patients was light perception to hand movement. The early postoperative visual acuity was between 1/18 and 0.2 in more than half of the patients. Seven eyes had to be enucleated. Six months after surgery, visual acuity could be gathered only for 50 % of the patients. Of these, 7 patients had visual acuity from hand movement to finger counting, 10 patients 1/60-0.2, 3 patients 0.25-0.4 and 10 patients 0.5-1.0. 35 patients (more than 1/3) with endophthalmitis were referred to us on a friday or monday.
Discussion: The postoperative results show that immediate vitrectomy is indicated when there are signs of vitreous infiltration.
Department of Ophthalmology Charité, Humboldt University, Augustenburger Platz 1, D-13353 Berlin