Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Postoperative Endophthalmitis Follow-up

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

Further Outpatient Care

Initially, administer topical therapy hourly and taper only after clinical improvement is seen.

Examine patients on a daily basis during the initial treatment period to ensure adequate sterilization of the vitreous cavity, to control intraocular inflammation, and to identify the need for additional intervention.

In the EVS, a total of 44 patients (10.5%) underwent an additional procedure during the first week after initial treatment, with 6 undergoing a procedure due to a complication of the disease or treatment and 38 due to worsening inflammation.[23] Of the patients in the TAP group that underwent repeat intraocular cultures, 71% had persistent positive cultures, compared to 13% in the VIT group, suggesting that vitrectomy may be more effective in sterilization of the ocular contents.

The EVS also evaluated the need for additional procedures between 1 week and 1 year, the endpoint for follow-up care. A total of 26.9% of patients underwent a late additional procedure. The most common reasons for intervention included opacified posterior capsule (9.0%), retinal detachment (4.3%), recurrent endophthalmitis (3.3%), and glaucoma (2.6%).

Next

Complications

The main complication associated with postoperative endophthalmitis is severe visual loss. This occurs most commonly in patients who develop infections from virulent organisms (non–coagulase-negative staphylococci, streptococci, and gram-negative organisms), receive delayed treatment, or have vision worse than hand motion at presentation.[1, 13, 20]

An important late complication of treatment of postoperative endophthalmitis remains retinal detachment.[27] In a report from the EVS, retinal detachment can occur in 10% of patients after treatment. Possible factors involved include iatrogenic retinal tears at the time of vitreous tap, injection of antibiotics, vitrectomy, late tears associated with subtotal posterior vitrectomy, or just a consequence of the infection/inflammation and the secondary retinal necrosis. Prompt treatment of retinal detachment may result in good visual outcomes in select cases.[13]

Previous
Next

Patient Education

One of the most important factors related to good visual outcomes after postoperative endophthalmitis is prompt recognition and diagnosis. It is critically important to counsel patients to look for the early signs and symptoms of endophthalmitis (eg, pain, redness, decreased vision) and to contact the operating physician immediately if present. If diagnosed and treated promptly, most cases may result in acceptable visual outcomes.

Previous
 
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
  1. Endophthalmitis Vitrectomy Study Group. Microbiologic factors and visual outcome in the endophthalmitis vitrectomy study. Am J Ophthalmol. 1996 Dec. 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. 2006 Jun. 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. 1998 Feb. 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. 2002 Sep-Oct. 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. 2005 May. 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. 2005 Aug. 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. 2007 Jun. 33(6):978-88. [Medline].

  8. Mutoh T, Kadoya K, Chikuda M. Four cases of endophthalmitis after 25-gauge pars plana vitrectomy. Clin Ophthalmol. 2012. 6:1393-7. [Medline]. [Full Text].

  9. Wykoff CC, Parrott MB, Flynn HW Jr, Shi W, Miller D, Alfonso EC. Nosocomial acute-onset postoperative endophthalmitis at a university teaching hospital (2002-2009). Am J Ophthalmol. 2010 Sep. 150(3):392-398.e2. [Medline].

  10. 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. 2007 May. 114(5):866-70. [Medline].

  11. 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. 2005 Jul. 112(7):1199-206. [Medline].

  12. 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. 1995 Dec. 113(12):1479-96. [Medline].

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

  14. 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. 2008 Mar. 115(3):473-6. [Medline].

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

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

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

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

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

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

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

  22. Maalouf F, Abdulaal M, Hamam RN. Chronic postoperative endophthalmitis: a review of clinical characteristics, microbiology, treatment strategies, and outcomes. Int J Inflam. 2012. 2012:313248. [Medline]. [Full Text].

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

  24. Holland EJ, McDonald MB, Parekh JG, Sheppard JD. Antibiotic resistance in acute postoperative endophthalmitis. Ophthalmology. 2014 Nov. 121(11 Suppl):S1-9. [Medline].

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

  26. Chen JY, Jones MN, Srinivasan S, Neal TJ, Armitage WJ, Kaye SB. Endophthalmitis After Penetrating Keratoplasty. Ophthalmology. 2014 Sep 25. [Medline].

  27. Parke DW 3rd, Pathengay A, Flynn HW Jr, Albini T, Schwartz SG. Risk factors for endophthalmitis and retinal detachment with retained intraocular foreign bodies. J Ophthalmol. 2012. 2012:758526. [Medline]. [Full Text].

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

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.