Session Title: New Drug Treatment and Technology II
Session Date/Time: Sunday 20/09/2015 | 09:00-10:30
Paper Time: 09:56
First Author: : A.Kothari INDIA
Co Author(s): : A. Gupta V. Saravanan N. Venkatapathy
PURPOSE:Endophthalmitis is a grave complication of intraocular surgery. Timely, appropriate intervention is critical in ensuring good outcomes. Delay or uncertainty in etiological diagnosis results in continuation of empirical therapy, which can be fallacious.
Polymerase chain reaction (PCR) testing offers higher yield and sensitivity, but application in endophthalmitis management has been limited, due to low specificity and restricted availability of tests. A new patented PCR tool (DNA Macrochip, Xcyton Ltd, Bangalore) is now available for clinical use for rapid species specific identification in postoperative endophthalmitis. This study compares the utility of DNA macrochip test in the management of acute postoperative endophthalmitis.
Randomized trial included 39 patients with acute postoperative endophthalmitis after cataract surgery. Study had two arms. In the 'Conventional treatment' arm, cases were managed on the basis of microbiology report alone. In the 'DNA macrochip' arm, additional results of PCR based DNA macrochip were available to direct treatment.
Conventional management was started in cases of postoperative endophthalmitis. Initial tap for microbiology followed by antibiotic injection or surgery as needed. Subsequent treatment was guided by routine microbiology alone in 18 cases (Conventional arm) and with additional DNA macrochip results in remaining 21 eyes (DNA microchip arm). Parameters analysed were microbiological identification, number of interventions and antibiotics, change in treatment, number of days of hospital stay and visual gain.
The DNA macrochip arm had 85.7% identification rate compared to 27.8% with routine microbiology. Number of major interventions was less (1.2 vs 1.8) and minor interventions more (2.8 vs 2.1) in the DNA macrochip group, though this did not reach statistical significance. The number of antibiotics used was significantly less (2.4 vs 3.5) (p=0.011) and change in treatment was more common in the DNA macrochip group. Duration of hospital stay was shorter in the DNA macrochip group (p=0.09). Final visual acuity was better in the DNA microchip group, but the difference did not reach statistical significance. Differences in parameters were sharper when the comparison was done between cases with a positive microbiological identification (from any test) versus those undergoing empirical therapy.
Early and increased microbiological yield from DNA macrochip led to less major interventions, informed decision making and rational antibiotic choice with shorter hospital stay.