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Anterior chamber tap cytology in acute postoperative endophthalmitis: a case–control study
  1. Loic Leveziel1,
  2. Juliette Knoeri1,
  3. Marie-Helene Errera1,2,
  4. Alfred Kobal3,
  5. Christine Fardeau4,
  6. Nacim Bouheraoua1,
  7. José Alain Sahel1,2,
  8. Christophe Baudouin1,
  9. Jean-Philippe Nordmann1,
  10. Françoise Baudouin3,
  11. Lilia Merabet3,
  12. Vincent Borderie1
  1. 1Ophthalmology, Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Paris, Île-de-France, France
  2. 2Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
  3. 3Laboratory of Biology, Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Paris, Ile-de-France, France
  4. 4Ophthalmology, Hôpital Universitaire Pitié Salpêtrière, Paris, Île-de-France, France
  1. Correspondence to Professor Vincent Borderie, Ophthalmology, Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Paris 75571, France; vincent.borderie{at}upmc.fr

Abstract

Aims To determine anterior chamber tap cytology characteristics in acute postoperative bacterial endophthalmitis.

Methods 488 eyes of 488 patients were included in this retrospective case–control study. The study group included 93 eyes with bacteriologically documented endophthalmitis and 85 eyes with clinical endophthalmitis. The control group included 33 eyes with non-infectious postoperative inflammation, 116 eyes with acute uveitis and 161 cataract surgery eyes with no ocular inflammation. Cytological analysis, direct examination and microbiological cultures were performed in aqueous humour (AqH) samples. Inclusion criteria for the study group were the following: suspected endophthalmitis within 30 days following cataract surgery by phacoemulsification, secondary lens implantation, pars plana vitrectomy or intravitreal injection; best-corrected visual acuity (BCVA) <20/400; hypopyon or cyclitic membrane; absence of visibility of the retina; vitritis at a slit-lamp examination or in ultrasound B-scan.

Results Cell line counts (mainly polymorphonuclear neutrophils) were significantly higher in the two endophthalmitis study subgroups than in the three control subgroups. The study group showed a predominance of polymorphonuclear neutrophils as opposed to the three control subgroups including uveitis (p<0.00001). The best sensitivity/specificity was obtained using a polymorphonuclear neutrophil threshold of 10 per field (sensitivity, 0.90; specificity, 0.75). The sensitivity of the bacterial culture was 32% in the AqH. High neutrophil count was associated with poorer initial BCVA (rs=0.62; p<0.00001) and higher risk of retinal detachment during (p=0.04) and after (p<0.001) hospitalisation.

Conclusion Anterior chamber tap cytology is a quick and accessible tool complementary to culture and PCR for the management of acute postoperative endophthalmitis.

  • aqueous humour
  • infection
  • diagnostic tests/investigation
  • inflammation
  • microbiology

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Footnotes

  • Contributors LL: collection and/or assembly of data, data analysis and interpretation, manuscript writing and final approval of manuscript. JK, M-HE and VB: collection and/or assembly of data, data analysis and interpretation, manuscript writing, and final approval of manuscript. AK, CF and FB: manuscript writing and final approval of manuscript. NB, JAS, CB and J-PN: final approval of manuscript. LM: data analysis and interpretation, manuscript writing, and final approval of manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication All patients gave informed consent before surgery.

  • Ethics approval The local Ethics Committee (CPP-Ile-de-France, St-Antoine Hospital, Paris, France, registration number 13934) approved this study. Described research adhered to the tenets of the Declaration of Helsinki.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. All data relevant to the study are included in the article.

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