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Endophthalmitis, Postoperative: Differential Diagnoses & Workup

Author: Mehran Taban, MD, Vitreoretinal Fellow, Cole Eye Institute, Cleveland Clinic Foundation
Coauthor(s): William B Trattler, MD, Ophthalmologist, The Center for Excellence in Eye Care; Volunteer Assistant Professor of Ophthalmology, Bascom Palmer Eye Institute; William Lloyd Clark, MD, Consulting Staff, Palmetto Retina; Peter K Kaiser, MD, Consulting Staff, Department of Ophthalmology, Cole Eye Institute, Cleveland Clinic Foundation
Contributor Information and Disclosures

Updated: Nov 6, 2008

Differential Diagnoses

Endophthalmitis, Bacterial
Glaucoma, Phacomorphic
Endophthalmitis, Fungal
Glaucoma, Uveitic
Filtering Bleb Complications
Hemorrhage, Vitreous
Foreign Body, Intraocular
HLA-B27 Syndromes
Glaucoma, Lens-Particle
Phacoanaphylaxis
Glaucoma, Phacolytic
Vitreous Wick Syndrome

Other Problems to Be Considered

Rebound inflammation/iridocyclitis
Retained lens fragments
Complicated primary surgery

Workup

Laboratory Studies

  • Most clinicians obtain vitreous and aqueous samples for microbiologic identification of the offending organism.11

Imaging Studies

B-scan (ultrasound): Determine whether there is vitreous involvement of the inflammation. It is also important to note the presence of retinal and choroidal detachment, which is important in the management and prognosis.10,11,20

More on Endophthalmitis, Postoperative

Overview: Endophthalmitis, Postoperative
Differential Diagnoses & Workup: Endophthalmitis, Postoperative
Treatment & Medication: Endophthalmitis, Postoperative
Follow-up: Endophthalmitis, Postoperative
References

References

  1. Endophthalmitis Vitrectomy Study Group. Microbiologic factors and visual outcome in the endophthalmitis vitrectomy study. Am J Ophthalmol. Dec 1996;122(6):830-46. [Medline].

  2. Gibb AP, Fleck BW, Kempton-Smith L. A cluster of deep bacterial infections following eye surgery associated with construction dust. J Hosp Infect. Jun 2006;63(2):197-200. [Medline].

  3. Cruciani M, Malena M, Amalfitano G, et al. Molecular epidemiology in a cluster of cases of postoperative Pseudomonas aeruginosa endophthalmitis. Clin Infect Dis. Feb 1998;26(2):330-3. [Medline].

  4. Eifrig CW, Flynn HW Jr, Scott IU, et al. Acute-onset postoperative endophthalmitis: review of incidence and visual outcomes (1995-2001). Ophthalmic Surg Lasers. Sep-Oct 2002;33(5):373-8. [Medline].

  5. Taban M, Behrens A, Newcomb RL, et al. Acute endophthalmitis following cataract surgery: a systematic review of the literature. Arch Ophthalmol. May 2005;123(5):613-20. [Medline].

  6. West ES, Behrens A, McDonnell PJ, et al. The incidence of endophthalmitis after cataract surgery among the U.S. Medicare population increased between 1994 and 2001. Ophthalmology. Aug 2005;112(8):1388-94. [Medline].

  7. Prophylaxis of postoperative endophthalmitis following cataract surgery: results of the ESCRS multicenter study and identification of risk factors. J Cataract Refract Surg. Jun 2007;33(6):978-88. [Medline].

  8. Lundström M, Wejde G, Stenevi U, et al. Endophthalmitis after cataract surgery: a nationwide prospective study evaluating incidence in relation to incision type and location. Ophthalmology. May 2007;114(5):866-70. [Medline].

  9. Ng JQ, Morlet N, Pearman JW, et al. Management and outcomes of postoperative endophthalmitis since the endophthalmitis vitrectomy study: the Endophthalmitis Population Study of Western Australia (EPSWA)'s fifth report. Ophthalmology. Jul 2005;112(7):1199-206. [Medline].

  10. Results of the Endophthalmitis Vitrectomy Study. A randomized trial of immediate vitrectomy and of intravenous antibiotics for the treatment of postoperative bacterial endophthalmitis. Endophthalmitis Vitrectomy Study Group. Arch Ophthalmol. Dec 1995;113(12):1479-96. [Medline].

  11. Lemley CA, Han DP. Endophthalmitis: a review of current evaluation and management. Retina. Jul-Aug 2007;27(6):662-80. [Medline].

  12. Lalwani GA, Flynn HW Jr, Scott IU, et al. Acute-onset endophthalmitis after clear corneal cataract surgery (1996-2005). Clinical features, causative organisms, and visual acuity outcomes. Ophthalmology. Mar 2008;115(3):473-6. [Medline].

  13. Mandelbaum S, Meisler DM. Postoperative chronic microbial endophthalmitis. Int Ophthalmol Clin. Winter 1993;33(1):71-9. [Medline].

  14. Clark WL, Kaiser PK, Flynn HW Jr, et al. Treatment strategies and visual acuity outcomes in chronic postoperative Propionibacterium acnes endophthalmitis. Ophthalmology. Sep 1999;106(9):1665-70. [Medline][Full Text].

  15. Fang YT, Chien LN, Ng YY, et al. Association of hospital and surgeon operation volume with the incidence of postoperative endophthalmitis: Taiwan experience. Eye. Aug 2006;20(8):900-7. [Medline].

  16. Maxwell DP Jr, Diamond JG, May DR. Surgical wound defects associated with endophthalmitis. Ophthalmic Surg. Mar 1994;25(3):157-61. [Medline].

  17. Kunimoto DY, Kaiser RS. Incidence of endophthalmitis after 20- and 25-gauge vitrectomy. Ophthalmology. Dec 2007;114(12):2133-7. [Medline].

  18. Johnson MW, Doft BH, Kelsey SF, et al. The Endophthalmitis Vitrectomy Study. Relationship between clinical presentation and microbiologic spectrum. Ophthalmology. Feb 1997;104(2):261-72. [Medline].

  19. Busbee BG, Recchia FM, Kaiser R, et al. Bleb-associated endophthalmitis: clinical characteristics and visual outcomes. Ophthalmology. Aug 2004;111(8):1495-503; discussion 1503. [Medline].

  20. Doft BH, Kelsey SF, Wisniewski SR. Additional procedures after the initial vitrectomy or tap-biopsy in the Endophthalmitis Vitrectomy Study. Ophthalmology. Apr 1998;105(4):707-16. [Medline].

  21. Park SS, Vallar RV, Hong CH, et al. Intravitreal dexamethasone effect on intravitreal vancomycin elimination in endophthalmitis. Arch Ophthalmol. Aug 1999;117(8):1058-62. [Medline].

  22. Brick DC. Risk management lessons from a review of 168 cataract surgery claims. Surv Ophthalmol. Jan-Feb 1999;43(4):356-60. [Medline].

Further Reading

Keywords

postoperative endophthalmitis, eye infection, vitritis, hypopyon, bacterial infection

Contributor Information and Disclosures

Author

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.

Coauthor(s)

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 and American Society of Cataract and Refractive Surgery
Disclosure: Nothing to disclose.

William Lloyd Clark, MD, Consulting Staff, Palmetto Retina
William Lloyd Clark, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Ophthalmology, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

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, American Medical Association, Association for Research in Vision and Ophthalmology, Massachusetts Medical Society, and Society for Neuroscience
Disclosure: Nothing to disclose.

Medical Editor

Andrew W Lawton, MD, Medical Director of Neuro-Ophthalmology Service, Section of Ophthalmology, Baptist Eye Center, Baptist Health Medical Center
Andrew W Lawton, MD is a member of the following medical societies: American Academy of Ophthalmology, Arkansas Medical Society, and Southern Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

R Christopher Walton, MD, Professor, Director of Uveitis and Ocular Inflammatory Disease Service, Department of Ophthalmology, Assistant Dean for Graduate Medical Education, University of Tennessee College of Medicine; Consulting Staff, Regional Medical Center, Memphis Veterans Affairs Medical Center, St Jude Children's Research Hospital
R Christopher Walton, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Healthcare Executives, American Uveitis Society, Association for Research in Vision and Ophthalmology, and Retina Society
Disclosure: Nothing to disclose.

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
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, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
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