First Author: S.Malhorta INDIA
Co Author(s): D. Agarwal S. Chatterjee 0 0 0 0 0 0 0 0 0
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To study anatomical and visual outcomes and prognostic factors in post cataract cluster endophthalmitis after pars plana vitrectomy and intraocular antibiotics.
MGM Eye Institute,Raipur, India
Retrospective analysis of medical records of patients of post cataract cluster endophthalmitis referred to MGM Eye institute, Raipur, India was done from February 2005 to February 2012. Detailed history and demographic information comprising of duration of symptoms, time interval between the cataract surgery and presentation to the institution and diagnosis of endophthalmitis were recorded . Clinical features at presentation including presenting visual acuity, corneal or wound infiltrate, presence of hypopyon, presence of vitreous cells and optic disc visibility,type of cataract surgery performed , use of medications, standardized echography and photo-documentation findings were analysed.Microbiological evaluation of vitreous for smears, culture and antibiotic susceptibility patterns were also analysed.All patients in this study underwent vitreous biopsy with 3 port pars plana vitrectomy with intraocular antibiotics and steroids. Intravitreal antibiotics were a combination of amikacin(0.4mg in 0.1ml) or ceftazidime (2.25mg in 0.1ml) for empiric gram negative coverage and vancomycin(1mg in 0.1ml) for empiric gram positive coverage. Patients were followed till 3 months and at every visit comprehensive ocular examination was performed.
45 cases reported during this period in 7 different clusters.Small incision cataract surgery (SICS) was performed in 31 (68.88%) patients and extracapsular cataract extraction (ECCE) in 14 (31.11%) with posterior chamber intraocular lens implantation. Median interval between cataract surgeries to onset of symptoms was 3 days (range 1- 18 days) and that between onset of symtoms to presentation to institute was 2 days (range 1-28). Visual acuity at presentation was light perception (LP) in 30 (66.6%) eyes, corneal infiltrates in 18 (40%) eyes and hypopyon in 24 (53.33%) eyes .Vitreous smear positivity was (46.66%) in 21 vitreous samples and culture positivity was (82.22%) in 37 of 45 vitreous samples. Pseudomonas aeruginosa was commonest isolate in 6 clusters . Final visual acuity was 20/400 or better in 14 (31.11%)eyes,7 (15.5%) eyes developed phthisis bulbi. Univariate analysis with Fisher's test showed, poor visual acuity at presentation (p=0.0009), the presence of corneal infiltrate (p=0.0004), hypopyon (p=0.05), vitreous membranes on ultrasound (p=0.0005), and culture positivity (p=0.002) as factors associated with unfavourable visual outcome. Poor visual acuity at presentation (p<0.014) and vitreous culture positivity (p<0.03) was associated with unfavorable visual outcome on logistic regression analysis using Statistical Package for the Social Sciences (SPSS) version 16.
Early detection of post cataract cluster endophthalmitis cases and prompt management by vitreous surgery and intraocular antibiotics may lead to favorable visual outcome in patients. Poor visual acuity at presentation and vitreous culture positivity are factors associated with poor visual and anatomical outcome in cluster postcataract endophthalmitis .