Post-traumatic endophthalmitis: causative organisms and visual outcome

Purpose. Post-traumatic endophthalmitis makes up a distinct subset of intra ocular infections. The purpose of the present study was to identify the cau sative organisms and record the visual outcome after infectious endophthalm itis in eyes with penetrating trauma. Methods. We reviewed 18 consecutive cases of culture-positive endophthalmit is that developed after penetrating ocular trauma. All cases were treated w ith pars plana vitrectomy and intravenous and intraocular antibiotics. Results. The 15 males and 3 females ranged in age from 4 to 43 years (mean 25.1 +/- II years). Nine (50%) had intraocular foreign bodies. A single spe cies was isolated in 16 cases, and multiple organisms in two. Staphylococcu s epidermidis and gram-negative organisms were the most frequent and were c ultured either alone or in association with other organisms in respectively five (27.7%) and four cases (22.2%). Clostridium perfringens was isolated in three cases (16.6%). Bacillus was not found as a cause of endophthalmiti s. Final visual acuity was better than 20/400 in eight cases (44%). In five cases (27.7%), the eye was saved but visual acuity was counting fingers. T wo eyes (11%) had no light perception. The remaining three eyes (16.6%) wer e enucleated or eviscerated. Clostridium perfringens was isolated from two eyes and Aspergillus niger from one. Postoperative retinal detachment devel oped in four eyes, which were successfully operated. Conclusions. Organisms isolated in this series were similar to those in pre vious reports of post-traumatic endophthalmitis from other parts of the wor ld, except that the frequency of Clostridium perfringens isolation was high and no Bacillus species were cultured. In view of its devastating outcome, post-traumatic endophthalmitis must be treated promptly with vitrectomy an d intravitreal antibiotics.