Delayed- Versus Acute-Onset Endophthalmitis After Cataract Surgery

Abstract

Purpose To report a large consecutive case series of patients who developed delayed-onset and acute-onset endophthalmitis after cataract surgery. Design Retrospective consecutive case series. Methods The current study is a retrospective consecutive case series of patients treated between January 2000 and December 2009 for culture-proven endophthalmitis after cataract surgery. The study defined two groups after cataract surgery: acute-onset endophthalmitis (≤ 6 weeks after surgery) and delayed-onset endophthalmitis (> 6 weeks after surgery). Results A total of 118 patients met study criteria and included 26 delayed-onset cases and 92 acute-onset cases. The following clinical features and outcomes occurred in delayed versus acute-onset cases: (1) the presenting visual acuity was ≤ 5/200 in 31% versus 89%, (2) hypopyon was found in 46% versus 80%, (3) the most frequent isolate was Propionibacterium acnes (11/26) versus coagulase-negative Staphylococcus (57/92), (4) patients with the most frequent isolate achieved a visual outcome of ≥ 20/100 in 91% versus 56%. In delayed-onset cases, the intraocular lens was removed or exchanged in 19/26 (73%). Of these 19 cases, 13 achieved a visual outcome of ≥ 20/100. Conclusions Patients with delayed-onset endophthalmitis generally presented with better initial visual acuities, had a lower frequency of hypopyon, and had better visual outcomes compared to acute-onset patients. Propionibacterium acnes and coagulase-negative Staphylococcus species were the most common organisms cultured in delayed and acute-onset categories, respectively, and were associated with the best visual acuity outcomes in each group.

Endophthalmitis Caused by Achromobacter Xylosoxidans After Cataract Surgery

“…Shirodkar et al reported that recurrence of the infectious process in cases of delayed-onset endophtahlmitis is significantly decreased with pars plana vitrectomy, capsulectomy, and intraocular lens removal because of the removal of indolent organisms that remain in the capsular bag and on the intraocular lens. [16] The Achromobacter species have been shown to create a biofilm to survive otherwise toxic environments. [17] To our knowledge, this is the first report that shows histopathologic evidence of A. xylosoxidans on the lens capsule.…”

Endophthalmitis Caused by Staphylococcus Hominis and Two Different Colonies of Staphylococcus Haemolyticus After Cataract Surgery

“…1 Chronic or delayed-onset endophthalmitis typically presents 6 weeks to months after cataract surgery, and isolated organisms are often found to be less virulent bacteria such as Propionibacterium acnes or fungal pathogens, although some species of Gram-positive and Gramnegative bacteria have been found. 2,3 The majority of patients with delayed-onset endophthalmitis present with plaque in the capsular bag, and often vitrectomy surgery with injection of antimicrobial medication into the capsular bag with or without removal of the intraocular lens seems to be curative. 2,3 Although our patient presented at 1 month, the clinical features more closely resemble those of delayed-onset or chronic endophthalmitis as opposed to acute endophthalmitis where, on average, cases present with more profound eye pain, redness, and purulent inflammation within the first postoperative week.…”

Chronic post-operative iris prosthesis endophthalmitis in a patient with traumatic aniridia: a case report

“…In one study with 118 patients, post-treatment acuity of 20/40 or better was present in 50 % of CPOE patients and only 27 % of APOE patients. However, 89 % of those with APOE had a presenting visual acuity of 5/200 or worse, a far greater percentage than the 31 % of those with CPOE with 5/200 or worse visual acuity [13]. …”