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Impressum
Endophthalmitis following cataract surgery
Hesse Y., Spraul C. W., Lang G. K.
University of Ulm, Dept of Ophthalmology, Prittwitzstr. 43, D-89075 Ulm
Objective: Infectious endophthalmitis is a serious complication
following cataract surgery, since it often induces a substantial reduction
of visual acuity.
Methods: We retrospectively evaluated the clinical data of 53 patients
with endophthalmitis following cataract surgery that were treated at the
department of ophthalmology of the University Hospital in Ulm between
1995 and Mai 2001. Of those, 50 had been referred. Clinical presentation,
infecting organism, treatment and visual outcome were analyzed with a
follow-up ranging from two weeks up to 42 months (median: six months).
Results: In 52 patients endophthalmitis was proceeded by cataract
extraction, in one case by secondary IOL implantation. Confirmed microbiologic
growth was demonstrated from intraocular specimens in 26 of 40 operated
eyes (65%), the most frequent causative organisms were gram-positive coagulase-negative
Staphylococci (50%). All isolated bacteria were sensitive to a
combination of the antibiotics vancomycin and amikacin or vancomycin and
ceftazidime. Thirteen patients were treated with intravenous antibiotic
therapy alone. In 50% of patients, who initially were treated with intraocular
antibiotic injections alone required further therapeutic intervention
for recurrent disease. Only 9% of the patients who underwent initially
intraocular antibiotic injections combined with IOL removal or pars plana
vitrectomy with or without IOL removal required further surgical intervention.
Initial visual acuity was hand movements (median) and improved during
follow-up to 0.2 (median). In two cases Enterococcus faecalis was
identified as the causing organism of recurrent endophthalmitis. Scanning
electron micrographs demonstrated that these organisms were adherent to
the IOL and the capsular bag.
Conclusion: The severity of the endophthalmitis following cataract
surgery might be an important factor when considered different treatment
strategies. Aggressive initial treatment including IOL removal may be
associated with a lower frequency of recurrent disease because some bacteria
e.g. enterococci tend to adhere to the IOL and the capsular bag.