The incidence, clinical and microbiological profile and visual outcome of post cataract surgery endophthalmitis in a community based teaching eye care centre in South India

Session Details

Session Title: Free Paper Session 5: Anterior/Posterior Segment Surgery

Session Date/Time: Thursday 07/09/2017 | 11:00-12:30

Paper Time: 11:36

Venue: Room 117

First Author: : V.Baskaran INDIA

Co Author(s): :    P. Bhende   S. Krishnamoorthy                          

Abstract Details

Purpose:

To analyse the incidence, clinical & microbiological profile and visual outcome of endophthalmitis following cataract surgery in a community based teaching centre of a tertiary care hospital in South India.

Setting:

Retrospective consecutive case series analysis in a teaching institute in South India.

Methods:

Reviewed the data from the medical records of all the patients who reported with endophthalmitis following cataract surgery in our Centre between January 2010 and December 2015. Endophthalmitis cases following trauma, uveitis, and other intraocular surgeries were excluded. All patients with suspected endophthalmitis had aqueous tap done and sample sent for smear, polymerase chain reaction (PCR) analysis and culture. All eyes were treated with topical steroids, topical and intravenous antibiotics, cycloplegics and intravitreal injections as per standard protocol. Eyes not responding to treatment and fulminant forms were taken up for vitrectomy as per Endophthalmitis vitrectomy study (EVS) protocol. Vitreous aspirate was sent for analysis in cases of vitrectomy. Positivity for microorganism in any of the above tests were included in the study. Incidence, clinical and microbiological profile, treatment and final best corrected visual outcome (BCVA) were analysed.

Results:

42 out of 52112 patients (0.00081) who underwent cataract surgery developed endophthalmitis. Male: female ratio was 26:16. Mean time interval between surgery and presentation was 14.48±14.61 days. There was no statistical significance based on surgeon experience (p 0.424) or type of procedure. 76.2% had hypopyon and 23.8% had fibrin reaction (p 0.007). Eleven (26.2%) eyes needed vitrectomy, two eyes needed sclerocorneal patch graft and one underwent evisceration. Culture was positive 0.07% of eyes. Smear was positive for Gram negative bacilli in 16.7%, Gram positive cocci in 4.8% and fungus in 4.8% of cases. PCR was positive for eubacterial genome in 57.2%, pan fungal genome in 2.4% and both in 7.1%. In vitreous aspirate PCR was positive for eubacterial genome & P.acne in 3/11 (27.27%), eubacterial genome & panfungal genome in 1/11(0.09) for eubacterial genome alone in 1/11(0.09). Final mean BCVA improved from 6/120 to 6/18(P= 0.000<0.05). Eyes with no surgical intervention had better vision (85.8% improved to 6/9) compared to those needing surgery. Two eyes had retinal detachment at final follow-up.

Conclusions:

Incidence of endophthalmitis (0.00081) in community based training centre is comparable to that in literature. Gram negative bacilli was the commonest organism .Early detection can avoid surgery in large majority of cases and appropriate treatment result in better visual recovery. Eyes with no surgical intervention had better final vision. Need for surgical intervention and fungal infection were poor prognostic indicators.

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