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Delayed- versus acute-onset endophthalmitis after cataract surgery
Anita R Shirodkar1, Avinash Pathengay, Harry W Flynn
1Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Florida, USA. ashirodkar@med.miami.edu
American Journal of Ophthalmology
|October 28, 2011
Summary
Delayed-onset endophthalmitis after cataract surgery typically presents with better vision and outcomes than acute-onset cases. Propionibacterium acnes and coagulase-negative Staphylococcus were the most common culprits in delayed and acute cases, respectively.
Area of Science:
- Ophthalmology
- Infectious Diseases
Background:
- Endophthalmitis is a serious intraocular infection that can occur after cataract surgery.
- Distinguishing between acute-onset and delayed-onset endophthalmitis is crucial for understanding disease progression and outcomes.
Purpose of the Study:
- To analyze and compare clinical features and outcomes of delayed-onset versus acute-onset endophthalmitis following cataract surgery.
- To identify common causative organisms and their impact on visual prognosis in both endophthalmitis categories.
Main Methods:
- Retrospective analysis of a consecutive case series of 118 patients with culture-proven endophthalmitis post-cataract surgery.
- Patients were categorized into acute-onset (≤6 weeks) and delayed-onset (>6 weeks) groups.
- Clinical presentation, causative pathogens, and visual outcomes were compared between the two groups.
Main Results:
- Delayed-onset endophthalmitis (26 cases) presented with significantly better initial visual acuity (≤5/200 in 31%) and lower hypopyon frequency (46%) compared to acute-onset (92 cases; 89% and 80%, respectively).
- Propionibacterium acnes was the most frequent isolate in delayed-onset cases (11/26), while coagulase-negative Staphylococcus was most common in acute-onset cases (57/92).
- Visual outcomes of ≥20/100 were achieved in 91% of delayed-onset cases with P. acnes and 56% of acute-onset cases with coagulase-negative Staphylococcus. Intraocular lens intervention was common in delayed-onset cases (73%).
Conclusions:
- Delayed-onset endophthalmitis generally has a more favorable prognosis than acute-onset endophthalmitis after cataract surgery.
- The specific microbial etiology influences visual outcomes, with P. acnes and coagulase-negative Staphylococcus associated with better prognoses in delayed and acute settings, respectively.
- Prompt management, including potential intraocular lens intervention, is important for optimizing visual recovery in delayed-onset endophthalmitis.
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