Endophthalmitis caused by Haemophilus influenzae.

OBJECTIVE: To investigate the clinical settings, management strategies, antibiotic sensitivities, and visual acuity outcomes for eyes with endophthalmitis caused by Haemophilus influenzae. DESIGN: Retrospective, noncomparative, consecutive case series. METHODS: The medical records were reviewed of all patients treated for culture-proven H. influenzae endophthalmitis at a single institution between January 1, 1980, and December 31, 2002. MAIN OUTCOME MEASURES: Visual acuity and antibiotic sensitivities. RESULTS: The study included 16 eyes of 16 patients with a median age of 68 years (range, 6 months-83 years) and a median follow-up of 26 months (range, 2 months-15 years). Clinical settings included post-trabeculectomy (n = 7), post-cataract surgery (n = 6), post-pars plana vitrectomy (n = 1), post-secondary intraocular lens insertion (n = 1), and post-suture removal from an extracapsular cataract wound (n = 1). Eleven (69%) cases were of delayed onset (>6 weeks from surgery/event), with a median interval between surgery/event and presentation with endophthalmitis of 18 months (range, 44 days-21 years); 5 (31%) cases were of acute onset (median, 6 days; range, 2-14 days). Presenting visual acuity was hand movements or better in 7 (44%) eyes. A vitreous tap and inject was performed initially in 9 (56%) eyes, and a vitrectomy was performed initially in the remaining 7 (44%) eyes. All eyes received intravitreal antibiotics on the day of presentation, and 11 (69%) received intravitreal dexamethasone. In vitro testing of the H. influenzae isolates revealed that 14 of 16 (88%) were sensitive to vancomycin, ampicillin, and trimethoprim/sulfamethoxazole; 15 of 16 (94%) were sensitive to aminoglycosides (1 isolate was resistant to gentamicin); and all were sensitive to cephalosporins, fluoroquinolones, and carbapenems. The organisms were sensitive to at least 1 of the initial antibiotics administered in all cases. Final visual acuity was 5/200 or better in 6 (38%) eyes, and 6 (38%) eyes had a final visual acuity of no light perception. CONCLUSIONS: Endophthalmitis caused by H. influenzae is generally associated with poor visual outcomes despite prompt treatment with intravitreal antibiotics to which the organisms were sensitive.

Immediate postoperative use of a topical agent to prevent intraocular pressure elevation after pars plana vitrectomy with gas tamponade.

OBJECTIVE: To determine whether a single topical aqueous suppressant applied immediately after pars plana vitrectomy with long-acting gas tamponade prevents intraocular pressure (IOP) elevation. METHODS: Fifty patients who met the inclusion criteria and underwent pars plana vitrectomy with long-acting gas tamponade were randomized to receive a combination of timolol maleate and dorzolamide hydrochloride, long-acting timolol alone, dorzolamide alone, or placebo at the conclusion of surgery. The IOP was checked by a portable, handheld tonometer (Tono-Pen) at the conclusion of surgery and at 5 hours, 1 day, and 1 week after surgery. RESULTS: There were no significant differences in IOP among the groups at the conclusion of surgery. The IOP at 5 hours after surgery (27.0 vs 17.4 mm Hg; P<.001) and 1 day after surgery (26.1 vs 19.9 mm Hg; P =.01) showed a statistically significant difference between the placebo and timolol-dorzolamide groups. The timolol-dorzolamide group showed greater IOP control than either the timolol alone or the dorzolamide alone groups at 5 hours (P =.04 for both). CONCLUSION: The use of a single topical aqueous suppressant (timolol-dorzolamide) given after pars plana vitrectomy with long-acting gas tamponade effectively prevents significant postoperative IOP elevation at 5 hours and 1 day after surgery.