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A severe outbreak of post-phacoemulsification endophthalmitis caused by pseudomonas aeruginosa

Session Details

Session Title: Quick Fire Free Paper Session 03

Session Date/Time: Sunday 29/09/2013 | 08:30-09:30

Paper Time: 08:40

Venue: Hall C (Level 1)

First Author: R.Halfeld Furtado de Mendonca ITALY

Co Author(s):    R. Luz Leit?o Guerra   O. de Oliveira Maia Jr   W. Yukihiko Takahashi        

Abstract Details

Purpose:

The purpose of this study is to describe an outbreak of Pseudomonas aeruginosa endophthalmitis after phacoemulsification and foldable single piece intraocular lens implantation in the capsular bag, performed in two consecutive days at one peripheral ophthalmological clinic of Brazil. Clinical findings, treatment and outcome are discussed.

Setting:

Acute endophthalmitis is one of the most serious complication of cataract surgery and intraocular lens implantation.

Methods:

Forty five patients (twenty three men and twenty two women) with acute postoperative endophthalmitis underwent cataract surgery with intraocular lens implantation. The average age was 71,2 years (range, 56–83 years). The right eye (62%) was affected more often than the left eye (38%). The median interval between surgery and endophthalmitis onset was 5,5 days (range, 5-6 days). The visual acuity at the diagnosis was better than 20/40 in one patient (2%), from 20/40 to 20/200 in one patient (2%), from 20/400 to counting fingers in two patients (4%), hand movements in eleven patients (24%), light perception in thirty patients (68%). The patients underwent primary vitrectomy, anterior chamber irrigation and vitreous antibiotic injection. Vitreous and anterior chamber samples cultures were performed in all patients.

Results:

All patients were treated for endophthalmitis on the day of presentation. Anterior chamber irrigation, administration of intravitreous antibiotics and primary vitrectomy were performed in all the patients. Secondary vitrectomy (reoperation) was performed in the cases with poor response to the treatment. Pseudomonas aeruginosa was the isolated agent in twenty-six vitreous samples and in three anterior chamber samples. Visual acuity in 3-month follow-up were: one patient (2%) achieved a final visual acuity better than 20/40; eight patients (18%) achieved a final visual acuity from 20/40 to 20/200; six patients (13%) achieved a final visual acuity from 20/400 to counting fingers; eleven patients (25%) achieved a final acuity of hand movements; thirteen patients (29%) achieved a final acuity of light perception and six (13%) patients had no light perception at the last examination. None of these eyes underwent to evisceration or enucleation in a 3-months follow-up period.

Conclusions:

Endophthalmitis following cataract extraction can occur, despite this surgery can be nowadays considered a safe one. Endophthalmitis is a rare, but serious, postoperative complication of cataract surgery. It can have a devastating consequence on a patient’s vision. In the present study, it was impossible to identify the source of the outbreak.

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