POSTOPERATIVE ENDOPHTHALMITIS IN ASSOCIATION WITH DIABETES-MELLITUS

Background: Endophthalmitis continues to be a potentially devastating complication of ocular surgery, despite advances in microsurgical tech nique and infection-preventing measures. Patients with diabetes have a ltered immunity at various levels and may be more susceptible to infec tion after ocular surgery. The authors evaluate the associations betwe en diabetes mellitus and postoperative endophthalmitis. Methods: The r ecords of 162 consecutive patients treated over a 5-year period for en dophthalmitis occurring within 2 weeks of ocular surgery were retrospe ctively reviewed. Results: Twenty-one percent of this consecutive seri es of patients with endophthalmitis after surgery had diabetes mellitu s. Both the diabetic and nondiabetic groups were similar with respect to age, type of primary surgery, duration from surgery to onset of sym ptoms, presenting visual acuity, and management of endophthalmitis. Se venty-nine percent of the patients with diabetes and 68% of those with out diabetes had culture-proven endophthalmitis. Staphylococcus was re sponsible for 74% and 71% of the culture-positive cases, respectively. The patients with diabetes were more likely to have endophthalmitis s econdary to a gram-negative organism (P < 0.001) than those without di abetes (18.5% versus 5.7%). Visual outcome was worse in the diabetic g roup, although this may be related to preoperative visual status. Conc lusions: Twenty-one percent of this consecutive series of patients wit h endophthalmitis after surgery had diabetes mellitus. The patients wi th diabetes mellitus were more likely to have endophthalmitis caused b y gram-negative organisms and appear to have a poorer visual prognosis after treatment for endophthalmitis.