Outcome and Prognostic Factors for Traumatic Endophthalmitis over a 5-Year Period

Abstract

Purpose. To evaluate the outcome and identify the prognostic factors of traumatic endophthalmitis over a 5-year period. Methods. We reviewed the medical records of all the traumatic endophthalmities that we treated in our department over the last 5 years (2009–2013). We extracted the following parameters: age, gender, wound anatomy, associated ocular lesions, treatment, and initial and final visual acuities. We used the program SPSS version 20.0.0. for the statistical analysis of our data. Results. During the last 5 years, we treated 14 traumatic endophthalmities, representing 46.66% of all types of endophthalmities. The infection rate in open globe injuries was 8.13% and 34.78%, if an intraocular foreign body (IOFB) was associated. All the patients were males with the median age of 37 years. Initial visual acuities varied between light perception and 0.4 and the timing of treatment from a few hours to 10 days. We administered antibiotic and anti-inflammatory drugs, systemically and intravitreally, in all cases. We performed pars plana vitrectomy in 64.28% of cases. In 57.14% of cases, the final visual acuity was 0.1 or more. Conclusions. IOFBs increased significantly the risk for endophthalmitis. The worse prognostic factors were retinal detachment at presentation and delayed treatment. This trial is registered with IRCT2014082918966N1.

Endophthalmitis: state of the art

“…Posttraumatic endophthalmitis is an uncommon but important complication of open-globe injury ( Figure 5 ). 92 – 94 In recent years, the incidence of endophthalmitis following open-globe trauma has been reported to be between 0% and 12% 95 – 103 with rates as high as 35% when an intraocular foreign body (IOFB) is present. 94 …”

“…These include IOFB, traumatic lens rupture, corneal wound, retinal break/detachment, traumatic cataract/posterior lens rupture, dirty wound, long hospital stay, and rural location. 94 , 95 , 98 , 100 , 101 Delayed wound closure and primary repair (beyond 12–24 hours) have also been reported as important risk factors. 95 , 96 , 106 , 107 Tissue prolapse (iris, vitreous) and presence of hyphema may reduce the risk of endophthalmitis since they may act as a barrier against entrance of microbes.…”

Causative Microorganisms of Infectious Endophthalmitis: A 5-Year Retrospective Study

“…Posttraumatic endophthalmitis is an important complication of open globe injury, and the incidence has been reported in recent years to vary widely from 0.9% to 11.91% [ 1 – 5 ]. The spectrum of causative organisms varies and depends on the region and environment, the type of injury, the living environment, and the time from injury to wound repair [ 6 – 8 ].…”

Immune Inhibitor A Metalloproteases Contribute to Virulence inBacillusEndophthalmitis

“…[1][2][3][4][5][6]. Bacillus endophthalmitis occurs most often following ocular trauma involving a foreign body contaminated with this bacterium [7][8][9][10][11].…”

“…Despite treatment with antibiotics, anti-inflammatory drugs, and surgical intervention, more than 70% of patients with Bacillus endophthalmitis have been documented to have significant vision loss, and about 50% of those patients underwent evisceration or enucleation of the infected eye [7][8][9][10][11]. Because this feared infection is difficult to treat, there is great importance in identifying virulence factors of Bacillus that contribute to this blinding disease.…”