Clinical Analysis of Posttraumatic Endophthalmitis

PURPOSE: To evaluate the incidence, risk factors, clinical characteristics, treatment, and the visual prognosis of posttraumatic endophthalmitis. METHODS: Medical records of 322 eyes in 322 patients, who were diagnosed as penetrating ocular trauma from July 1996 to June 2002, were retrospectively reviewed. RESULTS: Posttraumatic endophthalmitis developed in 30 (9.3%) of the 322 patients. There was an increased relative risk of infection in cases with poor initial visual acuity, lens disruption, delayed primary repair, and delayed use of systemic antibiotics. Of the 30 cases with infection, 12 (40%) achieved visual acuity of 0.1 or greater. In cases with poor initial visual acuity and with lens disruption, visual outcome was poorer. CONCLUSIONS: Risk factors for the development of posttraumatic endophthalmitis were poor initial visual acuity, lens disruption, delayed primary repair, and delayed use of systemic antibiotics. Poor prognostic factors were poor initial visual acuity and lens disruption.

Clinical Aspects of Infectious Endogenous Endophthalmitis

Infectious endogenous endophthalmitis is a relatively rare, but seriously devasting disease. To evaluate clinical aspects of this disease, we performed a retreospective study on 7 eyes of 7 patients who had been treated with this diagnosis from July 1994 to January 1998 at Asan Medical Center. The preceding systemic diseases consisted of liver abscess, non-small cell lung cancer, spontaneous bacterial peritonitis, acute cholangitis, cystitis, systemic candidiasis. Microorganisms were recovered in blood culture in 4 of them(3 Klebsiella pneumoniae and one Candida albicans). One among these patients also revealed culture positive for Klebsiella pneumoniae in the vitreous as well as in his blood. All patients received intravitreal vancomycin and amikacin injection following vitreous and aqueous tapping. Four patients underwent pars plana vitrectomy as the second procedure and 2 of them expired. At the final follow up, retina remained attached succesjully in six of 7 eyes, yet the visual outcome was so poor that only two recovered over 5/200 or better. Infectious endogenous endophthalmitis has guarded prognosis since causative microorganisms are often extremely virulent, detection of this disease is likely to be delayed and appropriate management can not be started immediately. High index of suspicion for the diagnosis and the intensive treatment are strongly suggested to achieve the best result.