PROGNOSIS OF THE POSTOPERATIVE ENDOPHTHALMITIS
E. Königsdörffer, R. Augsten, A. Oehme, J. Strobel
The survey summarizes the results of a retrospective study in patients with postoperative endophthalmitis. The aim is an evaluation of some prognostic aspects.
Patients: 21 patients with postoperative endophthalmitis (10 female, 11 male; the age ranged from 9 to 95 years with a mean of 69.7 years; 14 patients from foreign clinics) received medical attendance in our hospital between 1991 and 1997. The following operations had been accomplished: phaco with PC lOL 6x, ECCE with PC IOL 8x, secondary IOL 4x, re-keratoplasty 1x, fistula revision after keratoplasty 1x and suture removal 2 months after PC lOL implantation 1x. The stages of the endophthalmitis were acute (10x), subacute (6x) and chronic ones (5x). 17 ppv (2x with IOL explantation and removal of the capsular sac including 1x keratoplasty), furthermore 2 front vitrectomies and 2 rinsings of the anterior chambers without vitrectomy were necessary. All patients received medical treatment with antibiotics (intraocular and systemic). The postoperative span for care amounted to 1 to 36 months (mean 10.4 months). The microbiological investigations included cultures of the material from the vitreous body and the anterior chamber as well as the conjunctiva.
Result: By the end of the clinical attendance the visus of the patients was at least 1/25 (71 %) or 0.4 (24 %). Patients with a preoperative visus of hand motion had a better postoperative visus than patients with a preoperative visus which was worse (light perception). Moreover, patients with chronic or subacute endophthalmitis had a better visus than patients with an acute endophthalmitis. In chronic or subacute stages frequently an improvement of the visus was possible some weeks after operation. In cases with an acute development, however, the visus improvement stagnated and sometimes the visus became worst. The germ spectrum included Staphylococcus epidermidis, Staphylococcus aureus, Streptococcus sanguis, Propionibacterium acnes and other bacteria. The best postoperative visus was found after infection with Staphylococcus epidermidis.
Conclusion: Prognostic factors for the postoperative endophthalmitis are the visus, the results of the germ cultures and the progress of the endophthalmitis (acute, subactue or chronic stages). In the date of operation or intravitreal antibiotic therapy the visus is supposed to be at least hand motion. In this way postoperatively a better visus is to expect.
University Eye Hospital, BachstraEe 18, D-07740 Jena