Advertisement

Post-traumatic endophthalmitis

      Abstract

      Objective

      To establish risk factors for the occurrence of post-traumatic endophthalmitis, to observe the efficacy of prophylaxis, and to describe the clinical features of post-traumatic endophthalmitis.

      Design

      Partially prospective consecutive case–control study.

      Participants

      A total of 250 consecutive patients admitted to a single ophthalmic hospital with open globe injuries during a 3-year period were included.

      Methods

      Patients with post-traumatic endophthalmitis were identified prospectively and added to an endophthalmitis database. All open globe injuries during the same time period were identified through a retrospective search of inpatient admissions, and their charts were reviewed. Information collected from all patient files included patient age; gender; injury setting (indoor/outdoor); wound contamination; nature of injury (site on eye, lens involvement, retained intraocular foreign body); mechanism of injury (penetration/perforation/rupture/ruptured surgical wound); prophylactic antibiotic administration, including route and timing; timing of primary repair; lensectomy at the time of primary repair; and depot corticosteroid at the time of primary repair. Any association between these parameters and the subsequent development of endophthalmitis was investigated. Any association between endophthalmitis and final visual acuity (VA) and also enucleation was evaluated.

      Main outcome measure

      Development of endophthalmitis.

      Results

      The frequency of endophthalmitis after open globe injury was 6.8%. The following factors were associated with the subsequent development of endophthalmitis by univariate analysis: dirty wound (14.3% vs. 4.1%, P = 0.01), retained intraocular foreign body (13.0% vs. 4.4%, P = 0.02), lens capsule breach (12.8% vs. 3.2%, P = 0.01), delayed primary repair (≥12 hours) (11.3% vs. 2.9%, P = 0.02), and rural address (10.1% vs. 4.3%, P = 0.07). Risk factors identified after multivariate analysis were dirty injury (odds ratio [OR], 5.3; 95% confidence interval [CI)], 1.5–18.7), breach of lens capsule (OR, 4.4; 95% CI, 1.2–15.6), and delay in primary repair (per hour: OR, 1.013; 95% CI, 1.002–1.024). None of the following factors was found to be associated with post-traumatic endophthalmitis: patient age, gender, injury setting, site of injury on eye, mechanism of injury, antibiotic administration, lensectomy at the time of primary repair, and depot corticosteroid at the time of primary repair. Final VA tended to be worse in eyes with endophthalmitis (P = 0.08). Endophthalmitis did not significantly influence the frequency of enucleation/evisceration (5.9% vs. 4.3%, P = 0.55).

      Conclusions

      Delay in primary repair, ruptured lens capsule, and dirty wound were each independently associated with the development of post-traumatic endophthalmitis. Patients with ≥2 of these 3 risk factors had a particularly high frequency of infection.
      To read this article in full you will need to make a payment

      Subscribe:

      Subscribe to Ophthalmology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Verbraeken H.
        • Rysselaere M.
        Post-traumatic endophthalmitis.
        Eur J Ophthalmol. 1994; 4: 1-5
        • Nobe J.R.
        • Gomez D.S.
        • Liggett P.
        • et al.
        Post-traumatic and postoperative endophthalmitis.
        Br J Ophthalmol. 1987; 71: 614-617
        • O'Day D.M.
        • Smith R.S.
        • Gregg C.R.
        • et al.
        The problem of Bacillus species infection with special emphasis on the virulence of Bacillus cereus.
        Ophthalmology. 1981; 88: 833-838
        • Das T.
        • Choudhury K.
        • Sharma S.
        • et al.
        Clinical profile and outcome in Bacillus endophthalmitis.
        Ophthalmology. 2001; 108: 1819-1825
        • Boldt H.C.
        • Pulido J.S.
        • Blodi C.F.
        • et al.
        Rural endophthalmitis.
        Ophthalmology. 1989; 96: 1722-1726
        • Kuhn F.
        • Morris R.
        • Witherspoon D.
        • et al.
        A standardized classification of ocular trauma.
        Ophthalmology. 1996; 103: 240-243
        • Williams D.F.
        • Mieler W.F.
        • Abrams G.W.
        • Lewis H.
        Results and prognostic factors in penetrating ocular injuries with retained intraocular foreign bodies.
        Ophthalmology. 1988; 95: 911-916
        • Thompson J.T.
        • Parver L.M.
        • Enger C.L.
        • et al.
        Infectious endophthalmitis after penetrating injuries with retained intraocular foreign bodies. National Eye Trauma System.
        Ophthalmology. 1993; 100: 1468-1474
        • Duch-Samper A.M.
        • Menezo J.L.
        • Hurtado-Sarrio M.
        Endophthalmitis following penetrating eye injuries.
        Acta Ophthalmol Scand. 1997; 75: 104-106
        • Alfaro D.V.
        • Roth D.
        • Liggett P.E.
        Posttraumatic endophthalmitis. Causative organisms, treatment, and prevention.
        Retina. 1994; 14: 206-211
        • Alfaro D.V.
        • Roth D.B.
        • Laughlin R.M.
        • et al.
        Paediatric post-traumatic endophthalmitis.
        Br J Ophthalmol. 1995; 79: 888-891
        • Rubsamen P.E.
        • Cousins S.W.
        • Martinez J.A.
        Impact of cultures on management decisions following surgical repair of penetrating ocular trauma.
        Ophthalmic Surg Lasers. 1997; 28: 43-49
        • Sabaci G.
        • Bayer A.
        • Mutlu M.
        • et al.
        Endophthalmitis after deadly-weapon related open-globe injuries.
        Am J Ophthalmol. 2002; 133: 62-69
        • Forster R.K.
        Endophthalmitis.
        in: Tasman W. Jaeger E.A. Duane's Clinical Ophthalmology. Vol. 4. JB Lippincott, Philadelphia1999: 1-20
        • Thompson W.S.
        • Rubsamen P.E.
        • Flynn Jr, H.W.
        • et al.
        Endophthalmitis after penetrating trauma. Risk factors and visual acuity outcomes.
        Ophthalmology. 1995; 102: 1696-1701
        • Brinton G.S.
        • Topping T.M.
        • Hyndiuk R.A.
        • et al.
        Posttraumatic endophthalmitis.
        Arch Ophthalmol. 1984; 102: 547-550
        • Jonas J.B.
        • Knorr H.L.
        • Budde W.M.
        Prognostic factors in ocular injuries caused by intraocular or retrobulbar foreign bodies.
        Ophthalmology. 2000; 107: 823-828
        • Ariyasu R.G.
        • Kumar S.
        • LaBree L.D.
        • et al.
        Microorganisms cultured from the anterior chamber of ruptured globes at the time of repair.
        Am J Ophthalmol. 1995; 119: 181-188
        • Mieler W.F.
        • Ellis M.K.
        • Williams D.F.
        • Han D.P.
        Retained intraocular foreign bodies and endophthalmitis.
        Ophthalmology. 1990; 97: 1532-1538
        • Feist R.M.
        • Lim J.I.
        • Joondeph B.C.
        • et al.
        Penetrating ocular injury from contaminated eating utensils.
        Arch Ophthalmol. 1991; 109: 63-66
        • Folk J.C.
        • Lobes Jr, L.A.
        Bacterial endophthalmitis and traumatic hyphema resulting from ocular injuries during dental procedures.
        Can J Ophthalmol. 1981; 16: 151-152
        • Steele C.
        • Lucas D.R.
        • Ridgway A.E.
        Endophthalmitis due to caterpillar setae.
        Br J Ophthalmol. 1984; 68: 284-288
        • Doi M.
        • Ikeda T.
        • Yasuhara T.
        • et al.
        A case of bacterial endophthalmitis following perforating injury caused by a cat claw.
        Ophthalmic Surg Lasers. 1999; 30: 315-316
        • Alfaro D.V.
        • Davis J.
        • Kim S.
        • et al.
        Experimental Bacillus cereus post-traumatic endophthalmitis and treatment with ciprofloxacin.
        Br J Ophthalmol. 1996; 80: 755-758
        • Alfaro III, D.V.
        • Hudson S.J.
        • Kasowski E.J.
        • et al.
        Experimental pseudomonal posttraumatic endophthalmitis in a swine model. Treatment with ceftazidime, amikacin, and imipenem.
        Retina. 1997; 17: 139-145
        • Kelly L.D.
        • Steahly L.P.
        Successful prophylaxis of Clostridium perfringens endophthalmitis.
        Arch Ophthalmol. 1991; 109: 1199
        • Reynolds D.S.
        • Flynn Jr, H.W.
        Endophthalmitis after penetrating ocular trauma.
        Curr Opin Ophthalmol. 1997; 8: 32-38
        • Seal D.V.
        • Kirkness C.M.
        Criteria for intravitreal antibiotics during surgical removal of intraocular foreign bodies.
        Eye. 1992; 6: 465-468
        • Meredith T.A.
        Posttraumatic endophthalmitis.
        Arch Ophthalmol. 1999; 117: 520-521
        • Peyman G.A.
        • Carroll C.P.
        • Raichand M.
        Prevention and management of traumatic endophthalmitis.
        Ophthalmology. 1980; 87: 320-324
        • Peyman G.A.
        • Daun M.
        Prophylaxis of endophthalmitis.
        Ophthalmic Surg. 1994; 25: 671-674
        • Alfaro D.V.
        • Runyan T.
        • Kirkman E.
        • et al.
        Intravenous cefazolin in penetrating eye injuries. Treatment of experimental posttraumatic endophthalmitis.
        Retina. 1993; 13: 331-334
        • Mino de Kaspar H.
        • Engelbert M.
        • Thiel M.
        • et al.
        Intravenous imipenem prophylaxis in experimental endophthalmitis.
        Graefes Arch Clin Exp Ophthalmol. 2002; 240: 557-564
        • Mittra R.A.
        • Mieler W.F.
        Controversies in the management of open-globe injuries involving the posterior segment.
        Surv Ophthalmol. 1999; 44: 215-225
        • Sternberg Jr, P.
        • Martin D.F.
        Management of endophthalmitis in the post-Endophthalmitis Vitrectomy Study era.
        Arch Ophthalmol. 2001; 119: 754-755
        • Endophthalmitis Vitrectomy Study Group
        Results of the Endophthalmitis Vitrectomy Study. A randomized trial of immediate vitrectomy and intravenous antibiotics for the treatment of postoperative bacterial endophthalmitis.
        Arch Ophthalmol. 1995; 113: 1479-1496

      Linked Article

      • Posttraumatic Endophthalmitis
        OphthalmologyVol. 112Issue 10
        • Preview
          We read with interest the article by Essex et al.1 The authors apparently overlooked our articles,2,3 and because some of their statements are inaccurate, we offer some alternative explanations.
        • Full-Text
        • PDF