Postoperative Endophtalmities: therapeuthic results and Early vitrectomy

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Published Dec 7, 2017
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Vol. 95 No. 3 (2017): Issue Mar 2017

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Imen Zghal
Amine Souguir
Olfa Fekih
Amel Chebbi
Omar Romdhane
Hedi Bouguila
Leila Nacef

Abstract

Background: Postoperative endophthalmitis is a public health issue due to its bad prognosis; its treatment is both surgical and medical. Classically, surgical treatment was done if visual acuity is limited to light perception only.
Aim: To evaluate therapeutic results Of postoperative endophtalmitieS and to Compare therapeutics almost used intravitreal injection of antibiotics versus early vitrectomy.
Methods: It's a retrospective comparative study  includIng 120 cases of acute postoperative endophthalmitis hospitalized in a referral ophthalmology department between July 2007 and June 2013. A comparison was conducted between two groups of 24 and 94 patients; the first-line treatment was early vitrectomy for the first group and intravitreal antibiotic injection alone for the second group.
Results: The overall incidence rate was 0.38 %, Streptococcus and Staphylococcus Epidermidis where the most common bacterial strain (16 patients each). The treatment outcome was very favorable for 11 patients with final visual acuity  higher or equal to 2/10, the outcome was intermediate for 43 patients and poor for 66 patients because of final visual acuity lower than or equal to 1/20, loss of media transparency or anatomical or functional loss of the eye.
The prognostic factors statistically correlated to treatment outcome where intense initial inflammation (p<0.001), high bacterial virulence (p=0.002), bacteria culture positive to Streptococcus (p=0.024), a defectuous operative incision (p= 0.012), age over 80 (p=0.022) and posterior capsule rupture (p=0.013). Early vitrectomy group (group1) achieved a higher percentage of good outcome (60% vs 41.5%,  p=0.098 ).
Conclusion: Functional result is better in the Vitrectomy group than in the antibiotic intravitreal injections group whereas not Statically signifiant

Keywords:

Endophtalmitis- vitrectomy-intra vitreal injection-cataract-prevention- antibiotherapy

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References

  1. Salvanet-Bouccara A, Nodarian M. Chirurgie de la cataracte et risque infectieux. Reflexions Ophtalmol. 2000;36:5-11.
  2. Sampat KM, Garg SJ. Complications of intravitreal injections. Curr Opin Ophthalmol. 2010;21:178-83.
  3. Simunovic MP, Rush RB, Hunyor AP, Chang AA. Endophthalmitis following intravitreal injection versus endophthalmitis following cataract surgery: clinical features, causative organisms and post-treatment outcomes. Br J Ophthalmol. 2012;96:862-6.
  4. Ben Abdallah Nizar. Les endophtalmies post-opératoires :Aspects Diagnostiques et Thérapeutiques. Faculté de médecine de Monastir; 2009.
  5. Marcil S, Kabbaj H, Cherkaoui O, Nadah M, Alaoui AE, Seffar M. Endophtalmies bactériennes : étude rétrospective clinique et microbiologique à l'hôpital des spécialités de Rabat. J Fr Ophtalmol. 2012;35:499-502.
  6. Fisch A, Salvanet A, Prazuck T, Forestier F, Gerbaud L, Coscas G, et al. Epidemiology of infective endophthalmitis in France. The French Collaborative Study Group on Endophthalmitis. Lancet. 1991;338:1373-6.
  7. Results of the Endophthalmitis Vitrectomy Study. A randomized trial of immediate vitrectomy and of intravenous antibiotics for the treatment of postoperative bacterial endophthalmitis. Endophthalmitis Vitrectomy Study Group. Arch Ophthalmol. 1995;113:1479-96.
  8. De Smet MD, Carlborg EAE. Managing severe endophthalmitis with the use of an endoscope. Retina Phila Pa. 2005;25:976-80.
  9. Boscher CR. Endoscopy-assisted Vitrectomy for Severe Endophthalmitis. Retin Physician. 2012;38-58.
  10. Bhatia K, Pathengay A, Khera M. Vitrectomy in Endophthalmitis. VITRECTOMY. 2012;1.
  11. Chen E, Lin MY, Cox J, Brown DM. Endophthalmitis after intravitreal injection: the importance of viridans streptococci. Retina Phila Pa. 2011;31:1525-33.
  12. Diago T, McCannel CA, Bakri SJ, Pulido JS, Edwards AO, Pach JM. Infectious endophthalmitis after intravitreal injection of antiangiogenic agents. Retina Phila Pa. 2009;29:601-5.
  13. Artunay O, Yuzbasioglu E, Rasier R, Sengül A, Bahcecioglu H. Incidence and management of acute endophthalmitis after intravitreal bevacizumab (Avastin) injection. Eye. 2009;23:2187-93.
  14. Kuhn F, Gini G. Complete and early vitrectomy for endophthalmitis (CEVE) as today's alternative to the Endophthalmitis vitrectomy study. Vitreo-retinal Surgery [Internet]. Springer; 2007 [cited 2014 Jun 23]. p. 53-68. Available from: http://link.springer.com/content/pdf/10.1007/978-3-540-33670-9_5.pdf
  15. Kuhn F, Gini G. Vitrectomy for endophthalmitis. Ophthalmology. 2006;113:714.
  16. Lundström M, Wejde G, Stenevi U, Thorburn W, Montan P. Endophthalmitis after cataract surgery: a nationwide prospective study evaluating incidence in relation to incision type and location. Ophthalmology. 2007;114:866-70.
  17. Barreau G, Mounier M, Marin B, Adenis J-P, Robert P-Y. Intracameral cefuroxime injection at the end of cataract surgery to reduce the incidence of endophthalmitis: French study. J Cataract Refract Surg. 2012;38:1370-5.
  18. Barry P, Seal DV, Gettinby G, Lees F, Peterson M, Revie CW, et al. ESCRS study of prophylaxis of postoperative endophthalmitis after cataract surgery: Preliminary report of principal results from a European multicenter study. J Cataract Refract Surg. 2006;32:407-10
  19. Salvanet-Bouccara A. Complications infectieuses de la chirurgie de la cataracte. JFrOphtalmol. 2000;23:81-7.
  20. Endophthalmitis Study Group, European Society of Cataract & Refractive Surgeons. Prophylaxis of postoperative endophthalmitis following cataract surgery: results of the ESCRS multicenter study and identification of risk factors. J Cataract Refract Surg. 2007;33:978-88.
  21. Chiquet C, Cornut P-L, Benito Y, Thuret G, Maurin M, Lafontaine P-O, et al. Eubacterial PCR for bacterial detection and identification in 100 acute postcataract surgery endophthalmitis. Invest Ophthalmol Vis Sci. 2008;49:1971-8.
  22. Combey de Lambert A. Baseline Factors Predictive of Visual Prognosis in Acute Postoperative Bacterial Endophthalmitis in Patients Undergoing Cataract Surgery. JAMA Ophthalmol. 2013;131:1159.
  23. Busbee BG, Recchia FM, Kaiser R, Nagra P, Rosenblatt B, Pearlman RB. Bleb-associated endophthalmitis: clinical characteristics and visual outcomes. Ophthalmology. 2004;111:1495-1503.
  24. Leng T, Miller D, Flynn HW Jr, Jacobs DJ, Gedde SJ. Delayed-onset bleb-associated endophthalmitis (1996-2008): causative organisms and visual acuity outcomes. Retina Phila Pa. 2011;31:344-52.
  25. Bispo PJM, de Melo GB, Hofling-Lima AL, Pignatari ACC. Detection and gram discrimination of bacterial pathogens from aqueous and vitreous humor using real-time PCR assays. Invest Ophthalmol Vis Sci. 2011;52:873-81.
  26. Sugita S, Shimizu N, Watanabe K, Katayama M, Horie S, Ogawa M, et al. Diagnosis of bacterial endophthalmitis by broad-range quantitative PCR. Br J Ophthalmol. 2011;95:345-9.
  27. Cornut P-L, Thuret G, Creuzot-Garcher C, Maurin M, Pechinot A, Bron A, et al. Relationship between baseline clinical data and microbiologic spectrum in 100 patients with acute postcataract endophthalmitis. Retina Phila Pa. 2012 ;32:549-57.
  28. Goldschmidt P, Bensaid P, Semoun O, Chaumeil C. Approche rationnelle pour le traitement des endophtalmies post-chirurgicales des populations vivant dans des conditions de pauvreté. J Fr Ophtalmol. 2013;36:261-7.
  29. Hariprasad SM, Mieler WF, Holz ER. Vitreous penetration of orally administered gatifloxacin in humans. Trans Am Ophthalmol Soc. 2002;100:153-9.
  30. Ren H, Jiang R, Xu G, Chang Q, Lv J, Chen Q, et al. Endoscopy-assisted vitrectomy for treatment of severe endophthalmitis with retinal detachment. Graefes Arch Clin Exp Ophthalmol Albrecht Von Graefes Arch Für Klin Exp Ophthalmol. 2013;251:1797-800.