Prognosis of postoperative endophthalmitis

Background: The outcome of 20 patients is summarized in a retrospective stu dy to identify clinical findings that influence the long-term prognosis of postoperative endophthalmitis. Patients: Between 1991 and 1997 a total of 20 patients with postoperative e ndophthalmitis were admitted. Median age was 80 years (range: 9-95), 11 pat ients were male, 9 female,Sixteen pars-plana vitrectomies, 2 anterior vitre ctomies and 2 rinsings of the anterior chamber without vitrectomy were perf ormed. Furthermore, all patients received intraocular and systemic antibiot ic treatment. For microbiological investigation,specimens from vitreous, an terior chamber and conjunctiva were sent in. Long-term outcome was controll ed for an average of 14 months after treatment of the endophthalmitis (rang e: 4-36 months). Results: At the end of treatment, 40% of patients had a visual acuity of 0. 4 or better, 80% had 1/20 or better. Patients with a preoperative visual ac uity of at least hand movement had a better postoperative visual outcome th an patients with only light perception. Visual acuity was better in patient s with chronic endophthalmitis than in patients with acute or subacute endo phthalmitis. In patients with chronic or subacute endophthalmitis, improvem ent of visual acuity was found some months after the operation more often t han in patients with acute endophthalmitis. However, in 40% of cases with a n acute onset, no improvement or even worsening of the visual acuity was do cumented. Best postoperative results were found after infection with Staphy lococcus epidermidis and Propionibacterium acnes, Conclusion: Important prognostic factors of postoperative endophthalmitis a re visual acuity, the onset of the endophthalmitis (acute, subacute or chro nic) and the microbiological findings. At the time of surgery and antibioti c treatment, visual acuity should be at least hand motion to expect an impr ovement in the visual outcome.