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ENDOPHTHALMITIS DR ALI SALEHI

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Endophthalmitis Is a serious condition that can result in permanent and dramatic loss of vision. Early diagnosis and treatment are 2 of the most important factors related to good visual outcomes.

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Diagnosis Endophthalmitis is a clinical diagnosis that is confirmed by positive aqueous or vitreous culture. However, a negative culture does not exclude the diagnosis

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symptoms of endophthalmitis 1. floaters 2.mild to severe ocular pain 3. loss of vision 4.photophobia 5.Red eye

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Hallmark of endophthalmitis is vitreous inflammation but other signs include eyelid or periorbital edema ciliary injection chemosis anterior chamber reaction, (hypopyon) decreased visual acuity corneal edema and retinal hemorrhages

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Endophthalmitis can be divided into six categories: 1.Acute postcataract surgery (most common) 2.Chronic pseudophakic 3.Bleb-related 4.Posttraumatic 5.Endogenous 6.Fungal

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Bacteria involved Acute postoperative - coagulase-negative staphylococci staphylocuccus aureus and streptocuccus, Enterocuccus and gram negative species. Chronic postoperative - propionibacterium acnes and coagulase negative and corynebacterium species.

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Filtering bleb associated- streptococcus and staphyiococcus species and Haemophilus influenzae. Posttraumatic-Bacillus and staphylococcus species. Endogenous- S.aureus,Escheria coli and streptococcus species.

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Bacteriology Since coagulase-negative staphylococci are the predominant organisms colonizing the surface of the eye, and since most cases of endophthalmitis are due to the patient's own conjunctival flora it is not surprising that coagulase-negative staphylococci are the major pathogens in postcataract endophthalmitis

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31 percent of patients had negative or equivocal cultures. Organisms isolated in the confirmed culture-positive group included:

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Coagulase-negative staphylococci 70 percent Staphylococcus aureus 10 percent Streptococci 9 percent Other Gram positive organisms 5 percent Gram negative organisms 6 percent

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ACUTE POSTCATARACT ENDOPHTHALMITIS Is the most common form of endophthalmitis and, in the United States, is almost always due to bacteria. This complication occurs within six weeks of cataract surgery, with 75 percent of cases presenting in the first postoperative week.

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Postoperative E. POE a complication resulting from bacterial or fungal infection following cataract surgery. 2 form of POE Acute presenting up to 6 weeks post surgery.(80-90%) Chronic occurring months or even years after initial surgery. (10-20%)

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Incidences True incidences of POE is not known. Published reports indicate the incidence ranges from 1 in 350 to 1 in 1000 patients.

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Several studies have shown that bacteria can be isolated from the anterior chamber at the end of cataract surgery in 7 to 43 percent of cases but

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None of the study patients developed endophthalmitis, suggesting that the immune system is usually able to clear a small inoculum of relatively a virulent organisms

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