Primary Vitrectomy with Intravitreal Antibiotic Application in Postoperative and Posttraumatic Endophthalmitis
Authors:
M. Rehák; P. Wiedemann; P. Meier
Authors‘ workplace:
Oční klinika, Univerzita Lipsko, Německo, přednosta prof. Dr. med. P. Wiedemann
Published in:
Čes. a slov. Oftal., 64, 2008, No. 1, p. 21-25
Overview
Aim:
The aim of our study was to evaluate the results of the treatment of postoperative and posttraumatic endophthalmitis by means of primary vitrectomy with intravitreal antibiotic application.
Methods:
In 42 patients treated for postoperative and posttraumatic endophthalmitis during the period January 2000 – March 2006 at the University Department of Ophthalmology in Leipzig, Germany, EU, the postoperative visual acuity was followed – up. Furthermore, the results of microbial cultivation of the vitreous sample and the correlation between the final visual acuity and the causing etiological agent were evaluated. The treatment of endophthalmitis in 39 patients consisted of the primary vitrectomy with intravitreal antibiotics application; in three patients, solely the intravitreal injection of antibiotics was performed. In all patients, the antibiotics were administered locally and intravenously as well. The postoperative follow – up period lasted between 2 weeks to 24 months (median, 4.5 months).
Results:
The cause of endophthalmitis was in 31 (73 %) patients the cataract surgery or secondary implantation of the intraocular lens; and in 4 (10 %) patients the previous pars plana vitrectomy was performed. In 2 patients (5 %) the endophthalmitis developed after trabeculectomy and in 5 (21 %) patients, the endophthalmitis followed after perforating eye trauma. By means of microbiological cultivation, the agent was proved in 20 patients. The most common cause of endophthalmitis was Staphylococcus epidermidis. The postoperative improvement of the visual acuity we noticed in 39 patients. The final visual acuity better than 1/50 was reached by 88 % of patients, thereof in 52 % we proved at the end of the follow – up period the visual acuity better than 0.5.
Conclusion:
The primary vitrectomy with intravitreal application of antibiotics combining with local as well as intravenous applications of antibiotics is a successful method of endophthalmitis treatment; in our study, in 88 % of patients, the partial (orientational) vision was maintained.
Key words:
endophthalmitis, vitrectomy, intravitreal application of antibiotics, visual acuity
Sources
1. Bartz-Schmidt, K.U., Bermig J., Kirchhof B. et al.: Prognostic factors associated with the visual outcome after vitrectomy for endophthalmitis. Graefes Arch. Clin. Exp. Ophthalmol., 234, 1996: 51-58
2. Barry, P., Seal, D.V., Gettinby, G. et al.: ESCRS study of prophylaxis of postoperative endophthalmitis after cataract surgery: Preliminary report of principal results from a European multicenter study. J. Cataract Refract. Surg. 32, 2006: 407-410
3. Benz, M.S., Scott, I.U., Flynn, H.W. et al.: Endophthalmitis isolates and antibiotic sensitivities: a 6-year review of culture-proven cases. Am. J, Ophthalmol., 137, 2004: 38-42
4. Bermig, J., Meier, P., Retzlaff, C. et al.: Primäre Vitrektomie bei Endophthalmitis. Opthalmologe, 94, 1997: 552-556
5. Bohigian, G.M., Olk, R.J.: Factors associated with poor visual results in Endophthalmitis Am. J. Ophthalmol., 101, 1986: 332-341
6. Busbee, B.G.: Endophthalmitis: a reappraisal of incidence and treatment. Curr. Opin. Ophthalmol., 17, 2006: 286-291
7. Doft, B.H., Kelsey, S.F., Wisniewski, S. et al.: Treatment of endophthalmitis after cataract extraction. Retina, 14, 1994: 297-304
8. Fiscella, R.G., Pulido, J.: Postoperative Endophthalmitis. Ophthalmology, 113, 2006: 1472
9. Ernest, J., Rejmont, L., Pašta, J. et al.: Endoftalmitida po operaci katarakty. Čes. a slov. Oftalmol., 56, 2000:351-357
10. Han, D.P., Wisniewski, S.R., Wilson, L.A. et al.: Spectrum and susceptibilities of microbiologic isolates in the endophthalmitis vitrectomy study. Am. J. Ophthalmol., 122, 1996: 1-17
11. Holz, E.R.: Reducing endophthalmitis risk factors: where we stand. Am. J. Ophthalmol., 139, 2005: 1097-1098
12. Janknecht, P., Zuhlke, S., Hansen, L.L.: Did the spectrum of endophthalmitis change? A study comprising 13 years experience with operative therapy of endophthalmitis. Eur. J. Ophthalmol., 16, 2006: 300-305
13. Josephberg, R.G.: Endophthalmitis: the latest in current management. Retina, 26 (6 Suppl.), 2006: S47-50
14. Krummenauer, F., Kurz, S., Dick, H.B.: Epidemiological and health economical evaluation of intraoperative antibiosis as a protective agent against endophthalmitis after cataract surgery. Eur. J. Med. Res., 10, 2005:71-75
15. Kuhn, F., Gini, G.: Ten years after... are findings of the Endophthalmitis Vitrectomy Study still relevant today? Graefes Arch. Clin. Exp. Ophthalmol., 243, 2005: 1197-1199
16. Kuhn, F., Gini, G.: Vitrectomy for endophthalmitis. Ophthalmology, 113, 2006: 714
17. Meier, P., Wiedemann, P.: Endophthalmitis-klinisches Bild, Therapie und Prävention. Klin. Monatsbl. Augenheilkunde, 210, 1997: 175-191
18. Miller, J.J., Scott, I.U., Flynn, H.W. Jr. et al.: Acute-onset endophthalmitis after cataract surgery (2000-2004): incidence, clinical settings, and visual acuity outcomes after treatment. Am. J. Ophthalmol., 139, 2005: 983-987
19. The Endophthalmitis Vitrectomy Study Group: Results of the endophthalmitis vitrectomy study. A randomized trial of immediate vitrectomy and of intravenous antibiotics for the treatment of postoperative bacterial endophthalmitis. Arch. Ophthalmol., 113, 1995: 1479-1495
20. Pavan, P.R.: Endophthalmitis: management 25 years ago. Retina 26(6 Suppl), 2006: S45-46
21. Recchia, F.M., Busbee, B.G., Pearlman, R.B.: Changing trends in the microbiologic aspects of postcataract endophthalmitis. Arch. Ophthalmol., 123, 2005: 341-346
22. Soriano, E.S., Nishi, M.: Endophthalmitis: incidence and prevention. Curr. Opin. Ophthalmol., 16, 2005: 65-70
23. Svozílková, P., Říhová, E., Brichtová, M. et al.: Léčba chronické pooperační endoftalmitidy. Čes. a slov. Oftalmol., 62, 2006:404-410
24. Ta, C.N.: Minimizing the risk of endophthalmitis following intravitreous injections. Retina, 24, 2004: 699-705
25. Taban, M., Behrens, A., Newcomb, R.L. et al.: Acute endophthalmitis following cataract surgery. Arch. Ophthalmol., 123, 2005: 613-620
Labels
OphthalmologyArticle was published in
Czech and Slovak Ophthalmology
2008 Issue 1
Most read in this issue
- Sarcoidosis – a Case Report
- Malignant Melanoma of the Uvea in the Department of Ophthalmology, Faculty Hospital Brno Bohunice, Czech Republic, EU
- Primary Vitrectomy with Intravitreal Antibiotic Application in Postoperative and Posttraumatic Endophthalmitis
- Comparison of Contact and Immersion Techniques of Ultrasound Biometry