Janknecht P., Neß T., Schneider C. M.

Universitäts-Klinikum Freiburg

Objective: Once and again, there are clusters of endophthalmitis. However, they rarely emmenate from one institution after operation by one surgeon. 12 such patients were referred to us which enabled us to examine the different reaction on the same bacterium. Empedobacter brevis which may be found in water and soil was responsible for the infection. It was not known that E. brevis had up to date caused any eye infection in man.
Patients and Methods: Patient data were collected prospectively. Patients were followed-up in our institution - if possible - or by the referreing ophthalmologists. Mean follow-up was 357 days (range 166-452). There was an environment exam in the institution where the outbreak had occurred.
Results: Five men and 7 women (mean age 75y) developed an endophthalmitis 1 to 6 days after an uncomplicated cataract extraction. Patients reacted very different to the infection. E. brevis was found in the anterior chamber in 54.5% and in the vitreous in 87.5%.Patients were treated by anterior chamber lavage ± vitrectomy ± IOL removal. Visual acuity rose from preoperatively 0.02 to postoperatively 0.46. Biopsies from the referring hospital were taken from: irrigation solutions, tap water, phaco maschine. No source of the infection could be found.
Conclusion: Patients reacted very differently in spite of inocculation by the same bacterium. The reason for this may be a varying amount of bacteria which entered the eye, or an individual disposition. E. brevis has up to date not been made responsible for infection in man, but is potentially pathogenous for man and may - as shown - be responsible for an endophthalmitis.

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