Postoperative Endophtalmities: therapeuthic results and Early vitrectomy

Postoperative endophthalmitis is a public health issue due to its bad prognosis; its treatment is both surgical and medical. Classically, surgical treatment was done if visual acuity is limited to light perception only.

To evaluate therapeutic results Of postoperative endophtalmitieS and to Compare therapeutics almost used intravitreal injection of antibiotics versus early vitrectomy.

It's a retrospective comparative study  includIng 120 cases of acute postoperative endophthalmitis hospitalized in a referral ophthalmology department between July 2007 and June 2013. A comparison was conducted between two groups of 24 and 94 patients; the first-line treatment was early vitrectomy for the first group and intravitreal antibiotic injection alone for the second group.

The overall incidence rate was 0.38 %, Streptococcus and Staphylococcus Epidermidis where the most common bacterial strain (16 patients each). The treatment outcome was very favorable for 11 patients with final visual acuity  higher or equal to 2/10, the outcome was intermediate for 43 patients and poor for 66 patients because of final visual acuity lower than or equal to 1/20, loss of media transparency or anatomical or functional loss of the eye. The prognostic factors statistically correlated to treatment outcome where intense initial inflammation (p<0.001), high bacterial virulence (p=0.002), bacteria culture positive to Streptococcus (p=0.024), a defectuous operative incision (p= 0.012), age over 80 (p=0.022) and posterior capsule rupture (p=0.013). Early vitrectomy group (group1) achieved a higher percentage of good outcome (60% vs 41.5%,  p=0.098 ).

Functional result is better in the Vitrectomy group than in the antibiotic intravitreal injections group whereas not Statically signifiant.