ENDOPHTHALMITIS ASSOCIATED WITH MICROBIAL KERATITIS

Purpose: The purpose of the study is to investigate possible risk fact ors, organisms cultured, and visual acuity outcomes of endophthalmitis associated with microbial keratitis. Methods: Records were reviewed o f all patients with both positive corneal and positive intraocular cul tures at the Bascom Palmer Eye Institute between January 1, 1990, and March 31, 1995. Results: Thirteen (92.9%) of 14 patients identified ha d documented keratitis before the diagnosis of endophthalmitis was mad e. Thirteen (92.9%) patients recently had used 1% prednisolone acetate eye drops, 2 (14.3%) received oral prednisone, and 5 (35.7%) were bei ng treated for systemic conditions associated with relative immune dys function, Eight (57.1%) patients had a history of ocular surgery, and seven (50.0%) had wound abnormalities. Eight (57.1%) patients lacked a n intact posterior capsule, four (28.6%) had a corneal perforation, an d three (21.4%) had a history of dry eye. Gram-negative organisms (7), Staphylococcus aureus (3), streptococcal species (2), and fungi (4) w ere the most frequently isolated organisms. Coagulase-negative staphyl ococci were not isolated. Six (42.9%) patients achieved a post-treatme nt visual acuity of 20/200 or better. Three (21.4%) patients underwent enucleation or evisceration. Although not statistically significant, there was an association between appropriate initial antibiotic therap y and improved visual outcomes. Conclusion: Patients in whom endophtha lmitis associated with microbial keratitis develops have a frequent hi story of corticosteroid use, systemic conditions associated with relat ive immune dysfunction, lack of an intact posterior capsule, dry eye, wound abnormalities, and/or corneal perforation. In general, agents cu ltured consisted of organisms less frequently reported to be the causa tive agents in series of postoperative and post-traumatic endophthalmi tis. Post-treatment visual outcomes generally were poor.