Early repair, wound sealing reduce risk of endophthalmitis after open-globe trauma

Br J Ophthalmol. 2010;94(1):111-114.

Laceration was found to correlate with an elevated risk of endophthalmitis for open-globe injury, a study showed.

"Early primary repair, intraocular tissue prolapse and self-sealing of wounds were independent protective factors against the development of endophthalmitis," the study authors said.

The retrospective study examined records of open-globe injuries in 4,968 eyes of 4,865 patients treated over a 5-year period. Investigators excluded 173 eyes removed within 24 hours after trauma. The final study group comprised 4,795 eyes of 4,693 patients.

Study data showed that 571 eyes of 571 patients (rate of incidence: 11.91%) developed endophthalmitis. Patients with endophthalmitis had a median age of 26.19 years. Patients without endophthalmitis had a median age of 28.05 years.

Age, gender, lens breach, injury side and posterior zone of wounds did not significantly correlate with the incidence of endophthalmitis.

Fifty-three eyes (9.28%) underwent intravitreal antibiotic and corticosteroid therapy, and 305 eyes (53.42%) underwent vitrectomy.

At final follow-up, 96 eyes (16.81%) with endophthalmitis underwent total enucleation or evisceration; 368 eyes (8.71%) with open-globe injuries did not have endophthalmitis, the authors said.

"In our opinion, management of post-traumatic endophthalmitis is challenging, and it is difficult to evaluate the prognosis of visual acuity of eyes with post-traumatic endophthalmitis because visual prognosis is affected by a complex confluence of factors, which include varying degrees of tissue damage," the authors said. "However, on the whole, the final visual acuity of remained eyes improved markedly along with the recovery of anatomy and inflammation."