EPIDEMIC BACILLUS ENDOPHTHALMITIS AFTER CATARACT-SURGERY .1. ACUTE PRESENTATION AND OUTCOME

Objective: The purpose of the study is to report the clinical outcome of acute Bacillus endophthalmitis after cataract surgery. Design: The study design is a cohort study. Participants: Fourteen eyes of 14 pati ents with epidemic acute postoperative inflammation after exposure to bacteria-contaminated viscoelastic material were studied, Intervention : Three patients with milder clinical presentations were treated witho ut vitrectomy or antibiotics, Eleven patients with more severe infecti on were treated with vitrectomy as well as intravitreous and topical f ortified antibiotics, Main Outcome Measures: Final visual acuities wer e obtained in all 14 study patients. Results of microbiologic studies of aqueous and vitreous specimens from II vitrectomized eyes also were analyzed. Results-One patient with late presentation had severe infla mmation and had phthisis bulbi develop with no light perception. The r emaining 13 patients had successful resolution of inflammation after t reatment by I month of follow-up, Twelve of these 13 patients, includi ng 1 nonvitrectomized patient, had final visual acuities of 20/100 or better at 6 months' follow-up. Six patients, including two patients wi th nonvitrectomized eyes, had outcomes of 20/40 or better visual acuit y, Bacillus species were grown from all 11 (100%) vitreous and 7 (88%) of 8 aqueous specimens obtained from vitrectomized patients, as well as from the contaminated viscoelastic material remaining in the operat ing room. Conclusions: Postoperative Bacillus endophthalmitis need not result in poor outcome. Results depend on factors including bacterial load, specific bacterial species, timing of treatment, and immune sta tus of the patient.