Post-clear corneal phacoemulsification endophthalmitis: profile and management outcomes at a tertiary eye care center in western India

Abstract

BackgroundInfectious endophthalmitis is a serious sight threatening intraocular inflammation that results from exogenous or endogenous spread of organisms into the eye.A retrospective case series to study the profile of endophthalmitis following clear corneal phacoemulsification in western India between years 2008 and 2014 was held in the National Institute of Ophthalmology, Pune, India. Cases of endophthalmitis post-clear corneal phacoemulsification were reviewed pertaining to demography, clinical history, surgeon experience, surgical complications, time of onset following surgery, duration between onset of symptoms and presentation to the center, presenting visual acuity and at follow-ups, slit-lamp examination and ultrasound findings, vitreous tap culture results, treatment, and final functional and anatomical outcomes.ResultsOf 60 cases, 34 were operated in the tertiary center and 26 were referred. The incidence of endophthalmitis post clear corneal phacoemulsification performed at the tertiary center was 0.17%. Mean time delay between onset of symptoms and presentation to the tertiary care center was 2.6 days. Fifty percent cases were culture +ve, of which 80% were Gram +ve and 20% were Gram −ve, no fungal isolates. Coagulase –ve staphylococcus was the most common causative organism; rare isolates included Sphingomonas paucimobilis and Streptococcus mitis. Twenty-six eyes underwent primary vitrectomy. Mean presenting visual acuity was 2.14 ± 0.07 logMAR units which improved to logMAR 0.98 ± 0.12 at final follow-up. Presenting VA was >20/200 in 13.3% and <HM in 60% cases. 66.7% of eyes had visual improvement; 26.7% cases achieved VA 20/40 at final follow-up. Gram +ve and culture –ve cases, better presenting VA, and less time delay between onset and presentation had a favorable visual outcome.ConclusionsThe shift of the clinico-microbiological spectrum of endophthalmitis could be due to change in surgical technique to clear corneal phacoemulsification. Predictors of good visual outcome include good presenting visual acuity, early presentation to the center, culture negativity, and coagulase negative organisms.Electronic supplementary materialThe online version of this article (doi:10.1186/s12348-016-0115-y) contains supplementary material, which is available to authorized users.

FulminantSphingomonas paucimobiliskeratitis: case study and review of literature

“…Until, reported ocular infections caused by the organism including panophthalmitis, endophthalmitis and keratitis were seen either in peripartum phase or occurred after cataract surgery, penetrating ocular trauma or contact lens use (table 1). 6–15 However, in our patient, microbial keratitis was spontaneous in onset and no such risk factor could be identified. Adams reported a case of recurrent acute endophthalmitis postcataract surgery caused by the same organism that responded well to vitrectomy 6.…”

“…The same mechanism may also explain graft infection in our case. However, what remains unexplained is the constant unresponsiveness of the organism to aggressive medical and surgical management as in all the previously reported cases of ocular infections caused by S. paucimobilis , the infection responded well to commonly used antibacterial agents 4 6–17. Nevertheless, antibiotics resistant cases and cases requiring evisceration have also been reported by others 6 7 9 12.…”

“…Sphingomonas paucimobilis , previously known as Pseudomonas paucimoblis, is a type of gram-negative aerobic bacillus known to cause various systemic and ocular infections 2–17. It is usually associated with endophthalmitis and panophthalmitis and can also cause microbial keratitis.…”

Seleção de marcadores para a busca ativa de endoftalmite após cirurgia de catarata

“…Após a facectomia, os pacientes do GC necessitaram de poucas revisões cirúrgicas, que não estavam relacionadas a complicações infecciosas. Em contraste, os pacientes com endoftalmite foram submetidos a pelo menos uma e até três revisões cirúrgicas, como consequência direta da evolução do caso, o que está de acordo com estudos que descrevem o tratamento da endoftalmite 3,6,7,19 . O número de retornos para o acompanhamento pós-operatório de pacientes com endoftalmite (GE) foi significativamente maior do que o GC.…”

“…Os sinais clínicos de endoftalmite são frequentemente observados nos primeiros sete dias após a cirurgia 1,2 . Os sinais e sintomas mais comuns são: reação da câmara anterior, hipópio, edema de pálpebras e da córnea [3][4][5] , hiperemia conjuntival e vítreo turvo 1,4,6 . Em muitos casos, os pacientes se queixam de dor ocular ou baixa acuidade visual [3][4][5]7 .…”