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[Therapeutic strategy in delayed postoperative endophtalmitis: a report on 15 cases]
D Monnet1, M Labetoulle, M Lautier-Frau
1Service d'ophtalmologie du CHU de Bicêtre, Assistance Publique-Hôpitaux de Paris, 78, avenue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France.
Purpose:
To report the treatment strategies and visual acuity outcomes of chronic postoperative endophthalmitis.
Material:
and methods: The authors reviewed the records of 15 patients presenting 3 or more weeks after cataract surgery with intraocular inflammation and treated at Bicêtre Hospital from 1992 to 1998. Group I included 6 consecutive patients treated with vitrectomy and intravitreal antibiotic injection (vancomycin and cefazolin). Group II included 9 consecutive patients treated with intravitreal antibiotic injection (vancomycin and ceftazidime) and irrigation of the capsular bag (vancomycin). The minimum follow-up period was 1 year.
Results:
In group I, 2 patients had recurrent inflammation. In these patients, the capsular bag and the intraocular implant were removed. In 1 patient there was culture-proven Corynebacterium and in 1 patient a Staphylococcus epidermidis was found. Final visual acuity was 20/40 or better in 5 patients and 20/100 in 1 patient. Visual acuity improved in all cases. In group II no recurrence was seen in the 12-20 months of follow-up. In 2 patients there was proven Staphylococcus epidermidis and in one patient Propionibacterium acnes was found. Final visual acuity was 20/40 or more in 3 patients, 20/100 or more in 4 patients and less than 20/200 in 2 patients. Visual acuity improved in 8 cases.
Conclusions:
Intravitreal antibiotic injection with vitrectomy and intravitreal antibiotic injection with antibiotic irrigation of the capsular bag are both effective in the treatment of delayed chronic postoperative endophthalmitis; however, with the second approach, there is minimal surgical trauma and the intraocular implant is retained.