inflamation session - All India Ophthalmological Society

INFLAMMATION SESSION309Analysis of Risk Factors and Visual Outcome in Postoperative andPosttraumatic EndophthalmitisDr. Savita Ramkumar, Dr. Mohan Rajan, Dr. Sujatha Mohan, Dr. Bina John,Dr. Vijayalakshmi(Presenting Author: Dr. Mohan Rajan)The aim of the study was to identify the riskfactors and visual outcome in postoperativeand posttraumatic endophthalmitis. It was aretrospective interventional study, conducted atRajan eye care hospital in Chennai.29 consecutive patients of endophthalmitis wereincluded in the study of which 24 patients werepostoperative and 5 patients were posttraumaticendophthalmitis. The study period was duringJanuary 2004 – December 2007. The inclusioncriteria were all patients who underwent cataractsurgery between the age 20- 80 years and thosewho had ocular trauma. The exclusion criteriawere paediatric cataracts and patientsundergoing other procedures like intravitrealinjections, antiglaucoma surgeries, penetratingkeratoplasty, pterygium, vitrectomy, strabismussurgery and suture removal.Detailed preoperative evaluation includinghistory , visual acuity, slit lamp examination,fundus examination and B scan was done. Aminimal period of follow up was for one year.Out of 29 patients, 14 patients were male and 15were female between 20 – 80 years. 9 patients hadDiabetes. Patients who developedendophthalmitis within 14 days (21 eyes) wasdefined as acute onset and more than 6 weeks (8eyes) was chronic onset. Visual acuity at the timeof presentation for most of the patients was poorand 5 eyes were eviscerated.Among postoperative patients 9 underwentextracapsular cataract extraction, 3 underwentsmall incision cataract surgery and 12 underwentphaco emulsification with intraocular lens. Inposttraumatic patients, 2 had stick injury and oneeach had vegetable, needle and thorn injury.In the postoperative patients, 8 had posteriorcapsular tear and others were uneventful.Surgeries were done by trained as well aspostgraduate doctors of which the latter had aprolonged duration more than 45 minutes.Patients who underwent phacoemulsification,wound was sutured in 6 patients, 5 were notsutured and 1 was scleral incision.Culture positive among postoperative patientswas 75% and in posttraumatic patients was 100%.In culture positive postoperative patients (10eyes) 55% was Gram positive, (6 eyes) 33% wasGram negative and (2 eyes) 11% waspolymicrobial organisms.Secondary complication like retinal detachmentoccurred in 10 eyes (42%) in postoperativeendophthalmitis and 4 eyes (80%) in theposttraumatic endophthalmitis.Average number of interventions which includedvitrectomy and intravitreal injections ofantibiotics were 2 in the Gram positiveendophthalmitis and 3 each in Gram negativeand fungal endophthalmitis.The organisms isolated were susceptible to thecommonly used drugs like vancomycin andaminoglycosides.Visual outcome was categorized as improved,status quo and worse. 8 eyes improved (able toread 2 lines more than at the time ofpresentation), 7 eyes become worse (able to read2 lines less than at the time of presentation) in thesnellen’s chart and 14 eyes remained the same.Anatomical outcome was categorized as good,phthisis and status quo. 7 eyes became phthisicaland 10 eyes remained status quo.Statistical analysis of the study was done usingone sample t test. It was concluded that elderlypatients above 60 years (14 eyes) had badprognosis. Diabetic patients had poorer visualoutcome. Intraoperative complication likeposterior capsular tear with extracapsularextraction had poor prognosis. Prolongedsurgical time, those done by the trainee doctorslead to endophthalmitis. Sutureless clear cornealtemporal phacoemulsification lead toendophthalmitis. Further, culture positive Gramnegative organisms and fungal endophthalmitishad poor visual prognosis. Acute severepresentation had poor visual outcome whereaschronic late onset did reasonably well.Secondary complication like retinal detachment,posttraumatic endophthalmitis and patients withacute severe onset had poor anatomical andvisual outcome.