ENDOPHTHALMITIS CAUSED BY THE COAGULASE-NEGATIVE STAPHYLOCOCCI .1. DISEASE SPECTRUM AND OUTCOME

Purpose: The coagulase-negative staphylococci are the most common caus es of postoperative endophthalmitis. This study investigates the varia bility in the disease spectrum and visual outcome of coagulase-negativ e staphylococcal endophthalmitis in a large, single-center series. Met hods: Ninety consecutive cases of coagulase-negative staphylococcal en dophthalmitis were investigated retrospectively from two time periods, 1978 to 1982 and 1985 to 1987, separated by a transitional period in cataract surgery technique. Using a detailed protocol, inpatient, outp atient, and microbiologic records were analyzed. Six-month visual acui ty results were obtained. Results: Diagnosis frequently was delayed, o ften suspected only after hypopyon development. Thirty-seven percent o f patients presented more than 1 week after the inoculating event, and 13% presented after more than 1 month. Variable asymptomatic interval s and gradually worsening inflammatory prodromes are noted. Painless e ndophthalmitis occurred in 16%. Non-epidermidis infections comprised 2 8%. With vitrectomy/intraocular antibiotic management, 38% and 68% ach ieved visual acuities of 20/50 and 20/400, respectively. Overall, 10% of patients developed late retinal detachments. This occurred in only 4% of patients, with endophthalmitis occurring after cataract surgery. Conclusion: Ophthalmologists should become familiar with the emerging concepts of delayed-onset, chronic, and often painless endophthalmiti s in which the coagulase-negative staphylococci play a prominent role.