CATARACT SURGERY

RETROSPECTIVE ANALYSIS OF CASES OF ACUTE ENDOPHTHALMITIS AFTER SURGERY

Abstract

Purpose of study: To find out the prevalence and visual outcome of acute endophthalmitis after cataract surgery. Study Design: Retrospective. Period: 1st January 2001 to 31st December 2009. Setting: Wah Medical College, P.O.F. Hospital Wah Cantt, Rawalpindi. Materials and methods: Fifty cases of acute endophthalmitis who had undergone treatment. Each case of acute endophthalmitis was evaluated in terms of presentation, detailed examination, treatment and outcome. Microbiological culture of the vitreous aspirates was also done to identify the causative organism. The analysis was also meant to identify the prognostic factors of visual outcome of these cases. Results: Fifty patients presented with acute endophthalmitis out of the fifteen thousand cataract surgeries performed during the 9 year period. The incidence of endophthalmitis was 0.33% (95 % CI). A vitreous biopsy with intravitreal injection of antibiotics was done in all the cases presenting with acute endophthalmitis. Decreased visual acuity (90%) and pain (75%) were the main presenting features in these cases.. There were 36 (72%) culture positive cases, with staphylococci (50%) being the most common organism found. Vitreous biopsy yielded positive results in 36 (72%) patients while negative results with no microbial growth was found in 14(28%) patients. There were 20 (40%) growths of coagulase negative staphylococci, 5 (10%) growths of streptococci, 8 (16%) growths of coagulase positive staphylococci, and 3 (6%) of gram negative organisms. The final visual outcome was recorded after one month. 8 (16%) patients achieved 6/12 or better, 26 (52%) patients achieved moderately good visual acuity 6/60 to 6/12, while 16 (32%) patients achieved poor visual acuity of less than 6/60. Of the latter group who had poor visual acuity, 2 (4%) patients had only perception of light while 1 (2%) patient had no perception of light and 1 (2%) patient had blind and painful eye who had to undergo evisceration. 6 (16%) patients achieved 6/12 or better visual acuity. Conclusions: The incidence of endophthalmitis is consistent with other studies. Laboratory diagnosis of the vitreous aspirates helps in the treatment. Achieving a good visual outcome is possible with treatment of the cases of acute endophthalmitis.