2Numune Eğitim ve Araştırma Hastanesi, 1.Göz Kliniği Şefi, Ankara Purpose: To determine the effects of treatment modalities and risk factors on visual prognosis in patients presenting with severe visual loss (only light perception) related to acute endophthalmitis following cataract surgery.
Materials and Methods: The records of 31 patients who were treated with a diagnosis of endophthalmitis between August 2002 and May 2005 have been retrospectively reviewed. Those cases who had an etiology of endophthalmitis other than cataract surgery, no light perception or a visual acuity (VA) better than light perception at initial presentation, difficulty in determining VA, and a follow-up period less than 3 months were excluded from the study. The relations between visual outcome and demographic features, systemic and ocular risk factors, type of cataract surgery, and treatment modality were examined according to data obtained from a total of 15 eligible patients (8 male, 7 female), of whom 9 were operated in our clinic and 6 were referred from other clinics.
Results: Median age was 65 (23-82) years. After being hospitalized, a process of vitreous sampling for culture and a treatment protocol of topical, intravitreal, and systemic drugs as proposed by Endophthalmitis Vitrectomy Study were immediately initiated for all patients. Immediate pars plana vitrectomy (PPV) was not performed in the management of endophthalmitis. None of the patients were culture positive. Five out of 15 patients (33.3%) have had nasolacrimal canal (NC) obstruction as an ocular risk factor. Among patients who underwent cataract surgery in our clinic during the study period, the rate of NC obstruction was found to be statistically significantly higher in those who developed endophthalmitis (44.4%), than those who do not (1.8%) (p=0.033). Final VA was found to be increased an amount of [gtrthneq]1 Snellen line in 5 patients (33.3%). Of those, final VA was found to be [gtrthneq]0.2 in 4 patients (26.7%) and, [gtrthneq]0.5 in 2 patients (13.3%). Gender, type of cataract surgery, posterior capsule rupture, side of operated eye, and prodromal period did not appear to have a significant effect on final VA.
Conclusion: Although severe visual loss at initial presentation in patients with acute endophthalmitis after cataract surgery appears to result in a poor visual outcome, addition of immediate PPV to other treatment modalities such as topical, intravitreal, and systemic antibiotics may offer more acceptable visual results.
Keywords : Acute endophthalmitis, Cataract surgery, Pars plana vitrectomy