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Postoperative Endophthalmitis Clinical Presentation

  • Author: Hemang K Pandya, MD; Chief Editor: Hampton Roy, Sr, MD  more...
 
Updated: Jan 05, 2016
 

History

Patients with acute postoperative endophthalmitis typically present within 6 weeks of intraocular surgery with moderate to severe eye pain and decreased vision.

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Physical

The hallmark findings on ophthalmic examination are posterior and anterior chamber inflammation.[12, 13, 14]

Hypopyon is present in most cases.[12, 13, 14]

Other important findings include conjunctival hyperemia and chemosis, corneal edema, wound abnormalities, and associated eyelid or orbital inflammation.

In rare circumstances, patients may develop chronic, infectious endophthalmitis months to years after intraocular surgery. These patients exhibit indolent inflammation, which is initially responsive to corticosteroids, but over time, become refractory to therapy. Although conjunctival hyperemia, corneal edema, and anterior and posterior chamber inflammation are often present, rapid deterioration of vision and hypopyon are not seen frequently.[15, 16]

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Causes

Risk factors for development of postoperative endophthalmitis may include the following:

  • Increased operative time, low volume (experienced) surgeon [17]
  • Posterior capsule rupture/vitreous loss [13, 14]
  • Retained lens fragments
  • Inadequate sterilization of the operative field
  • Contamination of surgical instruments
  • Inadequate wounds (eg, leaky), as in some cases of sutureless clear corneal cataract incisions and sutureless sclerotomies [5, 6, 18, 19]

In the EVS, a prospective randomized clinical trial that evaluated the management of acute postoperative (cataract extraction or secondary IOL implantation) endophthalmitis, the most common organisms isolated were coagulase-negative staphylococci (70%), Staphylococcus aureus (9.9%), and streptococci species (9.0%). Infections caused by gram-negative organisms were seen in 6% of cases.[1, 20]

Endophthalmitis following other types of intraocular surgery has a similar microbiological profile with the following exceptions:

  • In filtering bleb-associated cases, the most common offending species is Streptococcus, followed by Haemophilus influenzae and coagulase-negative staphylococci. [13, 21]
  • In chronic postoperative endophthalmitis, an important causative organism is Propionibacterium acnes, a slow-growing, gram-positive bacillus that is associated with a characteristic white, intracapsular plaque that develops weeks to months and years after cataract surgery. [15, 16, 22]
  • Coagulase-negative staphylococci, fungal species, and unusual gram-negative organisms also have been reported to cause chronic postoperative endophthalmitis. [13]
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Contributor Information and Disclosures
Author

Hemang K Pandya, MD Fellow in Vitreoretinal Disease and Surgery, Dean McGee Eye Institute, University of Oklahoma College of Medicine

Hemang K Pandya, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Retina Specialists, Association for Research in Vision and Ophthalmology, Michigan State Medical Society, Michigan Society of Eye Physicians & Surgeons

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

R Christopher Walton, MD Professor, Director of Uveitis and Ocular Inflammatory Disease Service, Department of Ophthalmology, University of Tennessee College of Medicine

R Christopher Walton, MD is a member of the following medical societies: American Academy of Ophthalmology, Association for Research in Vision and Ophthalmology, Retina Society, American College of Healthcare Executives, American Uveitis Society

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy, Sr, MD Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy, Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Additional Contributors

Andrew W Lawton, MD Neuro-Ophthalmology, Ochsner Health Services

Andrew W Lawton, MD is a member of the following medical societies: American Academy of Ophthalmology, Arkansas Medical Society, Southern Medical Association

Disclosure: Nothing to disclose.

William Lloyd Clark, MD Palmetto Retina

William Lloyd Clark, MD is a member of the following medical societies: Alpha Omega Alpha, Association for Research in Vision and Ophthalmology, American Academy of Ophthalmology

Disclosure: Nothing to disclose.

William B Trattler, MD Ophthalmologist, The Center for Excellence in Eye Care; Volunteer Assistant Professor of Ophthalmology, Bascom Palmer Eye Institute

William B Trattler, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery

Disclosure: Received consulting fee from Allergan for consulting; Received consulting fee from Alcon for consulting; Received consulting fee from Bausch & Lomb for consulting; Received consulting fee from Abbott Medical Optics for consulting; Received consulting fee from CXLUSA for none; Received consulting fee from LensAR for none.

Peter K Kaiser, MD Consulting Staff, Department of Ophthalmology, Cole Eye Institute, Cleveland Clinic Foundation

Peter K Kaiser, MD is a member of the following medical societies: American Academy of Ophthalmology, Association for Research in Vision and Ophthalmology, American Medical Association, Massachusetts Medical Society, Society for Neuroscience

Disclosure: Nothing to disclose.

Acknowledgements

Mehran Taban, MD Vitreoretinal Fellow, Cole Eye Institute, Cleveland Clinic Foundation

Mehran Taban, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Ophthalmology, American Medical Association, Association for Research in Vision and Ophthalmology, and Phi Beta Kappa

Disclosure: Nothing to disclose.

References
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