Treatment strategies effective for stabilizing, improving vision in eyes with endophthalmitis

Can J Ophthalmol. 2009;44(1):88-94.

Acute endophthalmitis can lead to severe loss of vision, but long-term prognosis for visual acuity after treatment is generally positive.

In a population of 120 eyes in 114 patients treated for acute endophthalmitis, 78% of eyes had either stable or improved vision after a minimum of 6 months of follow-up. Treatment protocols varied by need and consisted of intraocular injection of antibiotics alone in 18 eyes, intraocular injection of antibiotics combined with vitrectomy in 85 eyes, topical antibiotics in nine eyes and enucleation of eight eyes.

Postoperative acute endophthalmitis was seen in 57 eyes and occurred after cataract surgery in 38 eyes. Endogenous acute endophthalmitis was seen in 49 eyes; 41 of those cases were immunocompromised. There were 14 cases of acute endophthalmitis after open globe injury.

The most frequent complications were 17 cases of vitreous or retinal hemorrhages, 17 cases of retinal detachment, seven cases of secondary glaucoma, three cases of recurrent endophthalmitis and three cases of choroidal detachment. Microbial analysis of 88 specimens revealed that Staphylococcus was the most common isolate.

Visual acuity was reduced by two lines or more at the end of follow-up in 18 eyes (15%), stable in 22 eyes (18%) and improved by two lines or more in 72 eyes (60%).