Endophthalmitis Today: A Multispecialty Ophthalmology Department Perspective

Abstract

Purpose To portray the current scene of endophthalmitis in a multispecialty ophthalmology department regarding etiologies and treatment guidelines. Methods Retrospective chart review of all patients diagnosed with endophthalmitis or suspected endophthalmitis from 2009 to 2012. Results A total of 24 eyes were diagnosed with endophthalmitis or suspected endophthalmitis during a 4-year period. The etiologies included endogenous endophthalmitis ( 6 ), blebitis ( 3 ), Ahmed valve implantation (3, 2 of them with late infection), postcataract surgery ( 3 ), intravitreal injections ( 4 ), penetrating injury ( 2 ), and other surgical procedures ( 3 ). Of the postcataract surgery cases, 1 was a congenital cataract surgery, and 2 were referrals. There were no endophthalmitis cases in 4603 adults undergoing cataract surgery in our department during this period. There were 14 positive cultures: 1 was candida and the rest bacteria. Ten of the bacteria cases were Gram-positive cocci (predominantly strep species), 3 were Gram-negative, and coagulase negative staphylococci were detected in 2 cases. Conclusions Our study indicates a significant change in the case mix of endophthalmitis. The past leading cause, cataract surgery, was dramatically reduced, and intravitreal injections became a major cause. The change in etiologies, and possibly in the microbial flora, warrants reconsideration of the rules that guided the management of endophthalmitis since the Endophthalmitis Vitrectomy Study.