Microbiologic spectrum and visual outcome of posttraumatic endophthalmitis

Abstract

Purpose: To identify the microbiologic spectrum and visual outcome of infectious endophthalmitis after open globe injuries.

Methods: We reviewed the medical records of all patients with culture-positive endophthalmitis after open globe injuries who were treated at King Khaled Eye Specialist Hospital and King Abdulaziz University Hospital (Riyadh, Saudi Arabia) between January 1, 1993, and December 31, 2003.

Results: Sixty-seven patients were identified. There were 55 males and 12 females (mean age +/- SD, 23.3 +/- 18.3 years; range, 2-65 years). The mean follow-up +/- SD was 18.8 +/- 23.9 months (range, 1-120 months). Twenty-nine eyes (43%) had intraocular foreign bodies (IOFBs). A single species was isolated from 59 eyes, and multiple organisms were isolated from 8 eyes (total number of infecting organisms, 78). The most common isolates were coagulase-negative staphylococci and Streptococcus species (26.9% of isolates each). Gram-negative organisms and fungi comprised 12.8% and 3.8% of isolates, respectively. Staphylococcus epidermidis comprised 37.1% of isolates in the group with IOFBs and 16.3% of isolates in the group without IOFBs (P = 0.0358). Streptococcus species comprised 41.8% of isolates in the group without IOFBs and 8.6% of isolates in the group with IOFBs (P = 0.0024). Final visual acuity was 20/200 or better in 30 eyes (47.6%). Visual acuity of 20/200 or better at presentation (P = 0.0474) and time from injury to presentation to our institutes of <1 day (P = 0.0348) were significantly associated with better visual acuity outcome. Final visual acuity of 20/200 or better was achieved in 61.9% of patients infected with nonvirulent organisms compared with 40.5% of patients infected with virulent organisms.

Conclusions: The most common organisms identified were coagulase-negative staphylococci and Streptococcus species. Clinical features associated with better visual acuity outcomes included better presenting visual acuity, early presentation to our institutes, and isolation of a nonvirulent organism. Posttraumatic endophthalmitis is associated with a poor visual prognosis.