POSTTRAUMATIC ENDOPHTHALMITIS - CAUSATIVE ORGANISMS, TREATMENT, AND PREVENTION

Background: Posttraumatic endophthalmitis is a rare complication of pe netrating eye injuries that results in blindness in potentially salvag eable eyes. Methods: 36 cases of posttraumatic endophthalmitis were ev aluated retrospectively to determine which factors were associated wit h visual loss. All cases were treated with intravenous and intraocular antibiotics. Pars plana vitrectomy was performed in 15 (41.7%) cases as an adjunct to treatment. Results: Patients ranged in age from 18 mo nths to 83 years, and included 30 men (83%) and 6 women (17%). Intraoc ular foreign bodies were present in 6 patients (16.7%), 9 (25%) had co rneal lacerations, 13 (36.1%) had corneoscleral or scleral lacerations , and 8 (22.2%) had ocular trauma of unknown type. Of the 36 eyes, 21 (58.3%) had positive culture results, and 10 of these (27.8%) had mult iple organisms. The most common isolates were Staphylococcus species ( 26.5%), Streptococcus species (20.6%), and Bacillus species (14.7%). I n 4 cases the diagnosis was made 6 or more years after injury. Final v isual acuity was 20/200 in 8 eyes (22.2%) and 20/300 in 1 eye. In 17 c ases (47.2%), the eye was salvaged but visual acuity was 5/200 or wors e, and 10 eyes (27.8%) were lost to enucleation or phthisis bulbi. Con clusion: Prompt diagnosis and early treatment with intraocular and sys temic antibiotics are important in the successful management of posttr aumatic endophthalmitis. The use of pars plana vitrectomy was associat ed with a good visual outcome when used in select cases.