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Post-traumatic Endophthalmitis: Risk-factors, Microbiological Diagnosis and Visual Outcome in the Period 1999-2000 in the Center of Ophthalmology, Ho Chi Minh City, Vietnam

1Tran T. P., 1Le M. T., 1Bui T. H., 2Nguyen M. T., 3Nguyen N. X., 3Küchle M.,
1Zentrum für Augenheilkunde (Ho Chi Minh Stadt)
2Institute for Microbiology (Ho Chi Minh Stadt)
3Friedrich-Alexander-Universität, Augenklinik (Erlangen)

Background: Posttraumatic endophthalmitis associated with penetrating injury represents a distict kind of intraocular infection. We report the incidence, microbiological presentation and visual outcome for endophthalmitis in Vietnam.
Patient and Methods: In a retrospective study medical reports of 515 patients with penetrating injury treated at Eye Hospital in Ho Chi Minh city, Vietnam, from 1/1999 to 5/2000 were reviewed and analysed. The treatment was standardized: 1. After vitreous-biopsie intravitreal jnjection of 0.1mg/0.1ml Gentamycine and 1mg/0.1ml Vancomycine; 2. Subconjunctival Injection of 25mg/0.5ml Vancomycine and 20mg/0.5ml Gentamycine; 3. Topical and systemic antibiotic treatment due to microbiological presentation; 4. Systemic Steroids treatment. Clinical parameters were evaluated for association with an increased risk of endophthalmitis.
Results: Out of 515 patients with penetrating injury 61 patients (11.8%) with endophthalmitis were treated and evaluated. Cultures of the vitreous aspirate were only in 50% of cases available. Microbiological examinations were positive for Gram-positive (51%), for Gram-negative bacteria (33%) and for fugal (16%). Risk factors found to be significant were: 1. a purely corneal wound; 2. wound length less than 5mm; 3. surgical primary repair more than 24 hour after trauma; 4. inadequate antibiotic treatment and 5. a rural injury setting. Time interval from trauma to diagnosis of endophthalmitis was 16.8±5.6 days. Follow-up period was 15.6±23.4 days. Visual acuity at the diagnosis of endophthalmitis in 96% of all patients was only finger counting or light perception. Enucleation was needed in 14% of patients, 29% of patients developed a phthisis bulbi. A visual acuity better than finger counting was reached in only 10% of all patients.
Conclusions: Posttraumatic endophthalmitis is still a big problem in Vietnam. Delay in primary wound closure or inaquadate antibiotic treatment worsen the prognosis pronouced. Comprehensive prophylactic antibiotic treatment at the time of injury repair is in dispensable. In risk eye particular attention should be paid to prophylaxe and sings of infection.