Clinical Observation on Exogeneous Endophthalmitis

Lee, Sang Yong; Kang, Goo Min; Chang, Moo Hwan

Abstract

PURPOSE: To evaluate the effectiveness of intravitreous injection of Vancomycin and Amikacin in exogenous endophthalmitis (before culture results are obtained), and the relationship between such empirical therapy and results of culture, susceptibilities of cultured organism to antibiotics, and visual prognosis.
METHODS
The authors conducted a retrospective study of 23 patients (23 eyes) who had been treated for endophthalmitis between May 1996 and November 2000.
RESULTS
The final vision was 0.15 and better in 18 eyes out of 23 eyes, and 5 eyes reported vision worse than 0.1. Endophthalmitis was associated with cataract surgery in 15 eyes, ocular traumja in 7 eyes, filtration surgery in 1 eye. Eyes with posttraumatic endophthalmitis had worse visual prognosis. When smear and culture was performed, 14 out of 23 eyes were tested positive, and all the obtained microorganisms showed sensitivity to vancomycin and amikacin. The results were similar between Gram positive and negative bacteria. When the onset of symptoms was within 1 week after intraocular operation, and when the patients with ocular trauma reported to the hospital within two days, the prognosis was relatively better. The use of intravitreous antibiotics alone yielded similar results compared to the use of combined systemic antibiotics. Two out of 5 eyes which underwent vitrectomy and 16 out of 18 eyes which did not undergo vitrectomy reported final vision of 0.15 or better.
CONCLUSIONS
When endophthalmitis is suspected, one should immediately perform diagnostic workup and the patient is immediately given intravitreous injection of vancomycin and amikacin. When smear and culture results are obtained later on, one can modify and improve the treatment modalities in an attempt to improve visual prognosis.