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Results in the treatment of bacterial endophthalmitis
Abstract:
Fifteen cases of confirmed and clinically suspected bacterial endophthalmitis seen at the Vitreous Clinic of Sydney Eye Hospital in the three-year period from July 1981 to July 1984 are reviewed. The predisposing factors are summarized; two cases followed secondary implantation of an intraocular lens and one case followed removal of sutures from a cataract section. All but one of the patients had been given topical, subconjunctival or systemic antibiotics prior to surgery. All but two of the patients had vitreous biopsies performed, and all of these patients in turn received intravitreal antibiotics, usually gentamicin and cephalothin. Positive cultures were obtained in nine cases (69%), including the two cases who had not received antibiotics prior to vitreous biopsy. Final visual acuities ranged from 6/6 to no perception of light (NPL). Delay of more than 36 hours between the onset of severe symptoms and intravitreal antibiotic treatment was associated with a poor visual outcome.
Insights
Prompt bacterial endophthalmitis diagnosis and treatment are crucial for vision. Early intravitreal antibiotic intervention, within 36 hours of symptom onset, significantly improves visual outcomes in bacterial endophthalmitis cases.
Area of Science:
- Ophthalmology
- Infectious Diseases
Background:
- Review of 15 bacterial endophthalmitis cases at Sydney Eye Hospital (1981-1984).
- Analysis of predisposing factors, including post-operative intraocular lens implantation and cataract surgery complications.
Observation:
- Most patients received pre-operative antibiotics.
- Vitreous biopsies were performed in most cases, followed by intravitreal antibiotics (gentamicin and cephalothin).
- Positive cultures obtained in 69% of cases.
Findings:
- Final visual acuities varied widely (6/6 to no light perception).
- A delay exceeding 36 hours between symptom onset and intravitreal antibiotic treatment correlated with poor visual prognosis.
- Cases not receiving pre-biopsy antibiotics showed positive cultures.
Implications:
- Highlights the importance of timely intravitreal antibiotic therapy for bacterial endophthalmitis.
- Suggests that pre-operative antibiotic use may not prevent all cases.
- Emphasizes the diagnostic value of vitreous biopsy and culture.