ABSTRACT
The purpose of this study was to investigate the causative organisms, the clinical characteristics, visual outcomes, and the incidence of acute endophthalmitis after cataract surgery. In this retrospective study, a chart review was performed for patients treated in a tertiary referral center for acute endophthalmitis after cataract surgery from January 2005 to December 2009. During the study period, 62 additional patients with acute postoperative endophthalmitis were referred to and treated in this center. Therefore the cohort comprised 70 patients [8 of whom underwent cataract surgery at our center, and 62 who were referred]. Demographic, clinical, and laboratory data were analyzed. The primary outcome measure was final visual acuity. P<0.05 indicated statistical significance During the study period, 7737 cataract surgeries were performed in this center. Eight [0.10%] of 7737 eyes developed acute postoperative endophthalmitis. Subgroup analysis indicated that extracapsular cataract extraction was associated with a fourfold higher risk of endophthalmitis compared with phacoemulsification. We found better initial visual acuity [VA] [>/=hand motion] [P<0.001] and negative cultures [P=0.021] were independently associated with a more favorable visual outcome. Patients with relative afferent papillary defect [RAPD] were associated with lower initial VA [P<0.001] and worse visual outcome [P=0.001]. Positive microbial cultures were found for 33 [42.9%] cases. Staphylococcus aureus was the most common organism isolated. Positive cultures were more frequently found in patients with RAPD. The "gram-positive coagulase-negative" and "no growth" groups had the best visual outcome. Associated keratitis and avoiding intraocular steroids were associated with the risk of evisceration. The visual outcome after endophthalmitis was generally poor and only one eighth of the eyes achieved a final corrected visual acuity of>/=20/200. Therefore, better treatment strategies are warranted. Immediate treatment is essential and the role of primary vitrectomy requires further investigation. In addition, RAPD, as an objective test, may complement VA for predicting the prognosis and planning the course of treatment
ABSTRACT
To evaluate the clinical and epidemiological characteristics of children with ocular trauma. We retrospectively reviewed the medical records of 278 children [aged 15 years or less] hospitalized with ocular injuries and treated as inpatients at a tertiary referral center in Shiraz, Iran, from 2005 to 2008. Nominal variables were evaluated with a Chi-square test. A P-value less than 0.05 indicated statistical significance. The cohort was comprised of 205 [74%] males, outnumbering females by a ratio of 2.81/1. The mean age was 7.6 +/- 3.96 years. Rural residents comprised 125 [45%] of the cohort. Sharp objects caused ocular injury in 211 [76%] cases, and 207 [74%] cases had open-globe injuries. The lens was injured in 62 [30%] cases at initial examination and 89 [43%] patients according to ultrasound examination [P = 0.006]. Twenty-eight cases [10%] developed post-traumatic endophthalmitis. Endophthalmitis was associated with needle injury [odd ratio [OR] = 19.25] and presence of intraocular foreign body [OR = 3.48]. Visual acuity of patients with closed-globe injuries was 20/200 or better on both initial and final examinations. Visual acuity of patients with open-globe injuries were in the range of light perception to 20/200. Trauma is an important cause of childhood ocular morbidity in southern Iran. Playing with sharp objects is an important cause of ocular trauma in children, and most injuries can be prevented by careful supervision