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Impressum
Endophthalmitis: Visual outcome in relation to therapy und etiology
Schebitz K., Mino de Kaspar H., Grasbon T., Schaumberger M., Kampik A.
Dept. of Ophthalmology, Ludwig-Maximilians-Universität, Mathildenstr. 8, 80336 Munich, Germany
Objective: Endophthalmitis is one of the most complicated ocular
diseases. For successful treatment, a rapid and reliable microbiologic
analysis is required.
Methods: From 1990-1997, in 120 cases of endophthalmitis the visual
outcome was analyzed with regard to the applied therapy and the etiology
(nosocomial: n=79, posttraumatic: n=20, endogenous: n=21). Treatment alternatives
were: 1.) Immediate pars plana-vitrectomy (ppV) with intraocular and systemic
antibiotics (n=73). 2.) Delayed (up to 8 days after diagnosis) ppV with
systemic and partly intraocular antibiotics (n=11). 3.) Systemic antibiotic
therapy alone without ppV (n=24). A rapid microbiologic analysis with
microscopy and direct susceptibility testing of the ocular specimens was
performed. The change of the visual acuity from the timepoint of initiation
of therapy to 4-6 weeks thereafter was assessed and compared in between
the three therapeutic groups.
Results: In therapy group 1, the median visual acuity improved
3 lines (median/interquartile range: 3/9,5). In group 2 and 3, the median
visual acuity did not change between the two timepoints (group 2: 0/7.0;
group 3: 0/6.0). In the etiologic groups 4-6 weeks after initiation of
therapy, the median visual acuity was 0.05 (range: PL-0.8) for nosocomial,
0.1 (PL-0.5) for posttraumatic and 0.03 (HM-0.6) for endogenous endophthalmitis.
In endogenous endophthalmitis, 4 eyes were enucleated, in nosocomial endophthalmitis
5 eyes, and in posttraumatic endophthalmitis 3 eyes.
Conclusion: In endophthalmitis, rapid surgical intervention with
the advantage of an early microbiologic diagnosis seems to improve the
visual outcome. The most favorable visual prognosis was found in cases
of posttraumatic endophthalmitis, the worst in endogenous endophthalmitis.
The enucleation rate was lowest for nosocomial endophthalmitis.