J Korean Ophthalmol Soc.  2007 Oct;48(10):1362-1368. 10.3341/jkos.2007.48.10.1362.

Risk Factors Leading to Enucleation or Evisceration in Endophthalmitis

• Kim JY
• Wang SJ
• Park CJ
• Lee SB

• KMID: 2210990
• DOI: http://doi.org/10.3341/jkos.2007.48.10.1362

Abstract

PURPOSE: To evaluate the risk factors associated with enucleation or evisceration in endophthalmitis patients.
METHODS
The medical records of endophthalmitis cases from January 1995 to July 2006 were reviewed retrospectively. The cases were divided into 2 groups, the enucleation/evisceration group (36 eyes of 36 patients) who underwent enucleation or evisceration and the intraocular procedures group (61 eyes of 60 patients) who received intravitreal antibiotics injection and/or vitrectomy. We analyzed these cases with respect to age, sex, initial visual acuity, causes of endophthalmitis, systemic disease, and causative organisms.
RESULTS
Older age (p=0.002), women (17/32, p=0.027), no light perception at presentation (33/37, p<0.001), endophthalmitis associated with corneal ulcer (25/25, p<0.001), and diabetes mellitus (14/20, p=0.001) were significantly associated with enucleation or evisceration.
CONCLUSIONS
Older age, poor initial visual acuity, endophthalmitis associated with corneal ulcer, and diabetes mellitus were strongly associated with enucleation or evisceration. If any of these factors are present, more intensive treatments are warranted to prevent loss of the eye.

Keyword

Diabetes mellitus; Endophthalmitis; Enucleation; Evisceration

MeSH Terms

Anti-Bacterial Agents
Corneal Ulcer
Diabetes Mellitus
Endophthalmitis*
Female
Humans
Medical Records
Retrospective Studies
Risk Factors*
Visual Acuity
Vitrectomy
Anti-Bacterial Agents

Reference

References

1. Afran SI, Budenz DL, Albert DM. Does enucleation in the presence of endophthalmitis increase the risk of postoperative meningitis? Ophthalmology. 1987; 94:235–7.

2. Tsai YY, Tseng SH. Risk factors in endophthalmitis leading to evisceration or enucleation. Ophthalmic Surg Lasers. 2001; 32:208–12.

3. Kim JS, Lee PT, Park YG. A clinical study of evisceration and enucleation in Kwangju and Chonnam population. J Korean Ophthalmol Soc. 1993; 34:345–51.

4. Rim YS, Yoon PY. A statistical observation of enucleation. J Korean Ophthalmol Soc. 1977; 20:299–302.

5. Seo BR, Min WK, Ahn BH. Treatment of infectious endophthalmitis. J Korean Ophthalmol Soc. 1991; 32:561–8.

6. Park KS, Park YG, Min WK, Ahn BH. Microbiological diagnosis and visual outcome of infectious endophthalmitis. J Korean Ophthalmol Soc. 1994; 35:1715–22.

7. Chung SE, Ham DI. Visual prognosis of culture proven bacterial endophthalmitis. J Korean Ophthalmol Soc. 2006; 47:1292–7.

8. Yoo SJ, Cho SW, Kim JW. Clinical analysis of posttraumatic endophthalmitis. J Korean Ophthalmol Soc. 2004; 45:69–78.

9. Williams DF, Mieler WF, Abrams GW, Lewis H. Results and prognostic factors in penetrating ocular injuries with retained intraocular foreign bodies. Ophthalmology. 1988; 95:911–6.

10. Koc F, Sen E, Demirbay P, et al. Factors influencing treatment results in pseudophakic endophthalmitis. Eur J Ophthalmol. 2002; 12:34–9.

11. Punnonen E, Laatikainen L. Prognosis of perforating eye injuries with intraocular foreign bodies. Acta Ophthalmol. 1989; 67:483–91.

12. Bohigian GM, Olk RJ. Factors associated with a poor visual result in endophthalmitis. Am J Ophthalmol. 1986; 101:332–4.

13. Thompson JT, Parver LM, Enger CL, et al. Infectious endophthalmitis after penetrating injuries with retained intraocular foreign bodies. Ophthalmology. 1993; 100:1468–74.

14. The Endophthalmitis Vitrectomy Study Group. Microbiologic factors and visual outcome in the endophthalmitis vitrectomy study. Am J Ophthalmol. 1996; 122:830–46.

15. Brinton GS, Topping TM, Hyndiuk RA, et al. Posttraumatic endophthalmitis. Arch Ophthalmol. 1984; 102:547–50.

16. Somani S, Grinbaum A, Slomovic AR. Postoperative endophthalmitis: incidence, predisposing surgery, clinical course and outcome. Can J Ophthalmol. 1997; 32:303–10.

17. Puliafito CA, Baker AS, Haaf J, Foster CS. Infectious endophthalmitis. Ophthalmology. 1982; 89:921–9.

18. Scott IU, Flynn HW, Feuer W, et al. Endophthalmitis associated with microbial keratitis. Ophthalmology. 1996; 103:1864–70.

19. Rowsey JJ, Newsom DL, Sexton DJ, Harms WK. Endophthalmitis: current approaches. Ophthalmology. 1982; 89:1055–66.

20. Scott IU, Flynn HW, Feuer W. Endophthalmitis after secondary intraocular lens implantation: a case-report study. Ophthalmology. 1995; 102:1926–31.

21. Kattan HM, Flynn HW Jr, Pflugfelder SC, et al. Nosocomial endophthalmitis survey: current incidence of infection after intraocular surgery. Ophthalmology. 1991; 98:227–38.

22. Phillips WB, Tasman WS. Postoperative endophthalmitis in association with diabetes mellitus. Ophthalmology. 1994; 101:508–18.

23. Moutschen MP, Scheen AJ, Lefebvre PJ. Impaired immune responses in diabetes mellitus: analysis of the factors and mechanisms involved. Relevance to the increased susceptibility of diabetic patients to specific infections. Diabetes Metab. 1992; 18:187–201.

24. Morain WD, Colen LB. Wound healing in diabetes mellitus. Clin Plast Surg. 1990; 17:493–501.

25. Lee SY, Kang GM, Chang MH. Clinical observation on exogenous endophthalmitis. J Korean Ophthalmol Soc. 2002; 43:60–6.

26. Baum JL. Current concepts in ophthalmology. Ocular infection. N Engl J Med. 1987; 299:28.

27. Diamond JG. Intraocular management of endophthalmitis: systemic approach. Arch Ophthalmol. 1981; 99:96–9.