Baseline factors predictive of visual prognosis in acute postoperative bacterial endophthalmitis in patients undergoing cataract surger

IMPORTANCE Although rare, postoperative endophthalmitis in patients undergoing cataract surgery can lead to anatomical or functional loss of the eye. Therapeutic strategies such as antibiotic prophylaxis and microbiological diagnosis are more effective with a target patient population. New prospective data are needed to identify prognostic factors. OBJECTIVE To identify baseline factors of visual prognosis in patients with acute bacterial endophthalmitis after cataract surgery. DESIGN Prospective study of consecutive patients undergoing cataract surgery, enrolled from March 1, 2004, through December 31, 2005. We analyzed outcomes to determine the effect on the final visual outcome, defined as poor (visual acuity [VA] worse than 20/100) or good (VA 20/40 or better) using univariate and multivariate analysis. SETTING Four academic hospitals. PARTICIPANTS Ninety-nine consecutive patients with cataract. INTERVENTION Corneal phacoemulsification. MAIN OUTCOMES AND MEASURES Factors related to the cataract surgery (complications), initial clinical presentation, and microbiological diagnosis and the final VA. RESULTS The significant baseline factors (at presentation) for good visual outcome (45% of the series) were the winter season, absence of complications during cataract surgery, initial VA, microbiological investigations revealing no microorganism or a coagulase-negative Staphylococcus species (CNSP), and fundus visibility. Quantitative factors associated with a good clinical prognosis were shorter duration of cataract surgery, younger age, and a hypopyon no greater than 1.5 mm. Significant factors associated with poor visual outcome were infection of the right eye, initial VA, corneal edema, a hypopyon larger than 1.5 mm, detection of bacterial species other than a CNSP, and the absence of fundus visibility. Multiple logistic regression analysis showed that high bacterial virulence was the only independent factor (odds ratio, 14.0 [95% CI, 2.7-71.0]; P = .001) for poor visual outcome. On the other hand, low bacterial virulence (odds ratio, 0.2 [95% CI, 0.03-0.6]; P = .01) and the absence of complications during cataract surgery (0.1 [0.01-0.4]; P = .003) were independent factors for good VA. CONCLUSIONS AND RELEVANCE Most clinical outcome factors in acute postoperative endophthalmitis can be identified at presentation. The bacterial virulence level is the main factor predictive of the final visual prognosis

Occurrence and risk factors for retinal detachment after pars plana vitrectomy in acute postcataract bacterial endophthalmitis

[b]Background/aims[/b]To report the incidence, risk factors and prognosis of retinal detachment (RD) in patients who had vitrectomy for acute bacterial endophthalmitis after cataract surgery.[b]Methods[/b]123 patients with acute postcataract endophthalmitis, consecutively treated with pars plana vitrectomy (PPV) were included by the French Institutional Endophthalmitis Study group, in a prospective multicentre cohort study. Risk factors of RD were analysed using logistic regression.[b]Results[/b]At the 6-month follow-up, the rate of post-PPV RD was 13% (n=16). The risk factors of post-PPV RD were diabetes (OR=4.7 (1.4-15.4), p=0.01) and visualisation of retinal vasculitis on the posterior pole (OR=3.8 (1.1-13.9), p=0.03) at the time of PPV. Postoperative RD occurred in 56% (n=9) of cases in the first month, in 31% (n=5) in the second month and in 6% (n=1) in the third month, with a mean delay of 4771days after PPV. The macula was detached in 12 cases (75%) and proliferative vitreoretinopathy grade C was present in seven cases. Final successful reattachment of the retina was obtained in 60% (n=9/15) of cases, with one (7/9) or two surgeries (2/9). Final visual acuity after surgical repair was 20/40 in 19% of cases, compared with 43% in patients without RD (p=0.05). [b]Conclusions[/b]RD is a major and severe complication of PPV performed in patients with acute postcataract endophthalmitis. Retinal vasculitis is a major risk factor of RD after PPV. Anatomical and functional outcome remain poor

Predictive factors of visual outcome in acute post-cataract endophthalmitis

Purpose: To study potential clinical and microbiological predictive factors of visual outcome in patients with acute endophthalmitis following cataract surgery. Methods: A prospective study included 100 patients in 4 University hospital.Factors related to the cataract surgery, the initial clinical presentation and the microbiological identification were analyzed according to the final visual outcome using univariate and multivariate (logistic regression) analysis. Results: 46% out of the patients had a final visual acuity less than or equal to 0.3 logMar (good visual outcome) at 6 months while 10% had only light perceptions. Patients with good visual outcome differed for the duration of cataract surgery, initial visual acuity, the visibility of fundus and the identification of a coagulase negative staphylococcus. In contrast, patients with a poor visual outcome were older, had more cornea oedema and a more important hypopion at the admission, more complications at the time of cataract surgery. Furthermore a bacterium was more frequently identified in this latter group. Multivariate analysis showed that age, complications at the time of cataract surgery, microbiological identification, pars plana vitrectomy were independent predictive factors. Conclusion: Factors of visual outcome in acute postcataract endophthalmitis identified in this prospective study were similar to that reported during the Endophthalmitis Vitrectomy Study 10 years ago. As part of the treatment, pars plana vitrectomy is associated with predictive factors of poor visual outcome. Identification of these predictive factors at presentation should allow a better management of patients needed an aggressive treatment

Factors of good visual outcome in acute post-cataract endophthalmitis (friends group)

International audiencePurpose: To analyze initial clinical factors of good visual outcome in patients with acute endophthalmitis following cataract surgery. Methods: A prospective study was performed in 4 University hospital (Dijon, Grenoble, Lyon, Saint-Etienne, FRIENDS group) on 100 patients with acute post-cataract endophthalmitis. Factors related to cataract surgery (complications), the initial presentation and the microbiological identification were analyzed according to the final visual outcome using univariate and multivariate analysis (SPSS 12.0). Results: 46% out of the patients had a final visual acuity less than or equal to 0.3 logMar (good visual outcome) at 6 months while 10% had light perceptions. Patients with good visual outcome differed from the patients with poor final visual acuity for the duration of cataract surgery (p=0.05), initial visual acuity (> LP, p=0.005), the visibility of fundus (p=0.04) and the identification of a coagulase negative Staphylococcus (p=0.05). On the other hand, patients with a poor visual outcome (> 0.3 LogMAR) were older (p=0.004), had more frequently cornea oedema (p=0.05) and a larger hypopion (p=0.01) at admission, more frequently complications at the time of cataract surgery (p=0.005), and a bacterium was more frequently identified (p=0.005). Multivariate analysis showed that age, complications at the time of cataract surgery and identification of bacteria were independent factors of visual prognosis. Conclusions: Factors of visual outcome in acute postcataract endophthalmitis identified in this prospective study (2004-2007) were similar to those reported by the EVS 15 years ago. Given the bias associated with the therapeutic strategy, pars plana vitrectomy is associated with predictive factors of poor visual outcome. Identificaton of these predictive factors at presentation should allow a better identification of patients needed an aggressive treatment

Genetic and Phenotypic Traits of Staphylococcus Epidermidis Strains Causing Postcataract Endophthalmitis Compared to Commensal Conjunctival Flora

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