ENDOPHTHALMITIS CAUSED BY THE COAGULASE-NEGATIVE STAPHYLOCOCCI .2. FACTORS INFLUENCING PRESENTATION AFTER CATARACT-SURGERY

Purpose: This study, comprising 60 patients with coagulase-negative st aphylococcal endophthalmitis which occurred after cataract surgery, wa s designed to define the variation in disease presentation and visual outcome and to evaluate statistically the role of the primary surgery and its management. Methods: An intensive evaluation of microbiologica l, inpatient, outpatient, and cataract surgery charts was made retrosp ectively using a standardized protocol. The predictive value of surgic al, iatrogenic, and clinical factors was analyzed for their influence on defined aspects of the disease pattern and of the visual results us ing multiple regression models, via a stepwise technique. Results: The re was commonly a significant asymptomatic latent period after catarac t surgery. The median diagnostic delay was 7 days; 22% of patients pre sented after 2 weeks and 12% after 1 month. Symptoms progressed longer than 3 days in 25% of patients. Ten percent had no pain. Clinical var iation proved largely unrelated to cataract surgery events and postope rative management; bacterial factors were implicated. Good visual outc ome was associated statistically with intensive topical corticosteroid in the symptomatic period, but was negatively associated with operati ve subconjunctival corticosteroid. Conclusions: The clinical variation in cases of postoperative coagulase-negative staphylococcal endophtha lmitis poses particular problems for diagnosis in the outpatient setti ng. Surgical and perioperative events (except corticosteroid use) prob ably can be disregarded in studies of endophthalmitis management.