Posters

Endophthalmitis after cataract surgery and intravitreal therapy: 5 year experience in Clinical Hospital Center Rijeka, Croatia

Poster Details

First Author: M.Bilen Babić CROATIA

Co Author(s):    M. Merlak   R. Grzetic-Lenac           

Abstract Details

Purpose:

To present our 5-year retrospective study of rare cases of acute postoperative endophthalmitis after cataract surgery and therapeutic intravitreal (IV) therapy, with a diagnostic algorithm and treatment modalities.

Setting:

Our study is a retrospective study that included cases of endophthalmitis in 5-year period from October 2010 to August 2015 at Department of Ophthalmology Clinical Hospital Center Rijeka, Croatia. During that period, 7871 cataract surgery were performed and 6824 intravitreal injections were administered with 6 cases of acute endophthalmitis.

Methods:

In our study 6 cases of acute endophthalmitis following cataract surgery and IVT were recorded, 2 cases after uncomplicated phacoemulsification and 4 cases after IV injection of Bevacizumab (1,25 mg/0,05mL). The age of patients was from 63 to 85 years. Our initial managment included complete ophthalmologic examination and B-scan ultrasonography. Our therapeutic manegement consisted of: in 3 eyes intravitreal antibiotics (Vancomycin 1mg/0,1 mL+ Ceftazidime 2,25 mg/0,1 mL); in 1 eye intravitreal antibiotics at 1st day and pars plana vitrectomy (PPV) with introperative IV antibiotics on 5th day; only PPV with intraoperative IV antibiotics in 2 eyes.

Results:

Intraocular sample of aqueous humor and vitreous was obtained in 4 eyes (67%). The sample was sterile in 1 (25%) and positive in 3 cases (75%) with isolated bacteria: Streptococcus oralis, Staphylococus species and Enterococcus faecalis. Initial visual acuity (VA) was light perception (LP) in 1 eye and hand movement in 5 eyes. In 50% of cases, with successful treatment, final VA was from 0,1 to 0,5 according to Snellen chart. In other 50% of patients, with heavy retinal injury, final VA was LP and no LP in 1 eye. Postcataract endophthalmitis rate is 0,025% and after IV therapy 0,058%.

Conclusions:

Endophthalmitis is rare but the most feared complication after ocular surgery because of a rapid course and potential for severe vision loss. Early diagnosis and treatment are essential to optimize visual outcome but still challenging. So endophthalmitis prevention should be a priority with interventions with minimal risk of side effects and low costs, like use of preoperative povidone iodine for ocular and periocular antiseptic cleaning, intracameral use of antibiotics at the end of cataract surgery and postoperative topical antibiotic therapy. Also clinicians should have a low threshold for recognition and treatment of suspected endophthalmitis. FINANCIAL DISCLOUSRE: NONE