Endophthalmitis after deadly-weapon-related open-globe injuries: risk factors, value of prophylactic antibiotics, and visual outcomes

doi:10.1016/S0002-9394(01)01320-4

American Journal of Ophthalmology

Volume 133, Issue 1, January 2002, Pages 62-69

https://doi.org/10.1016/S0002-9394(01)01320-4 Get rights and content

Abstract

PURPOSE: To identify clinical and microbiologic factors influencing the prevalence and visual outcomes in endophthalmitis after deadly-weapon-related open-globe injuries.

METHODS: In a retrospective study of 228 eyes of 212 patients with deadly-weapon-related open-globe injuries, clinical and microbiologic factors influencing the prevalence and visual outcome in endophthalmitis were analyzed in detail.

RESULTS: Twenty-nine eyes enucleated for irreparable damages at presentation were excluded. Nineteen eyes (18 patients) of 199 (186 patients) were associated with culture-proven endophthalmitis. Presence of grade 4 injury, a variable of Ocular Trauma Classification System, and lens disruption at presentation were the significant risk factors for development of endophthalmitis (P = .001; odds ratio = 15.9 [2.0 to 122.1]), and ([P < .001; odds ratio = 17.7 [2.3 to 136.3]), respectively. Favorable outcome (visual acuity of 5/200 or better) was achieved in only four eyes (21%). Five eyes (26.3%) were phthisical, and five eyes (26.3%) were enucleated or eviscerated. All eyes were under the coverage of prophylactic intravenous antibiotics when culture positivity was obtained. Except two eyes with Acinetobactersp., all were infected by gram-positive micro-organisms (89.5%), the most common of which (42%) was Staphylococcus epidermidis. None of the clinical characteristics and treatment modalities affected final visual outcome. Favorable outcome was associated with infection by the less virulent micro-organism S. epidermidis (P = .018; odds ratio = 0.50 [0.25 to 1.00]).

CONCLUSIONS: Endophthalmitis after deadly-weapon–related open-globe injuries has a dismal visual prognosis. Severity of injury and lens disruption are significant risk factors for development of endophthalmitis. Infection with a less virulent microbe is the only factor associated with favorable outcome.

Section snippets

Methods

Of 212 patients (228 eyes) with open-globe injuries, 18 patients (17 patients with unilateral and one patient with bilateral bacterial endophthalmitis at presentation and late onset of fungal endophthalmitis in one of the eyes) were identified as having clinically evident, culture-proven endophthalmitis by retrospective analysis of discharge diagnosis of the Department of Ophthalmology at Gülhane Military Medical Academy and Medical School, over 6 years.6 In this study, records were reviewed to

Results

All patients with endophthalmitis (18 patients, 19 eyes) were male army personnel who were injured by deadly weapons.6 Because we were not certain that they would have developed endophthalmitis, we excluded 29 eyes with irreparable damage that underwent enucleation immediately after trauma. One hundred ninety-nine eyes of 186 patients with open-globe injury were included in the study. Thus, the prevalence of culture-positive endophthalmitis was 9.5%. The mean age of patients with

Discussion

The age distribution of our selected population seems to be younger than that in reported series, because most of the patients were enlisted men. The prevalence of culture-proven endophthalmitis after open-globe injuries has been reported to range from 2% to 30%.1, 8, 12, 13 Nineteen of 199 eyes (9.5%) were associated with culture-proven endophthalmitis in this study. Twenty-nine eyes in which evisceration or enucleation was performed immediately after trauma, at the time of primary repair,

References (26)

D.P. Han et al.
Spectrum and susceptibilities of microbiologic isolates in the endophthalmitis vitrectomy study
Am J Ophthalmol
(1996)
J.C. Affeldt et al.
Microbial endophthalmitis resulting from ocular trauma
Ophthalmology
(1987)
G. Sobacı et al.
Deadly weapon-related open-globe injuriesoutcome assessment by the ocular trauma classification system
Am J Ophthalmol
(2000)
D. Pieramici et al.
A system for classifying mechanical injuries of the eye (globe)
Am J Ophthalmol
(1997)
H.C. Boldt et al.
Rural endophthalmitis
Ophthalmology
(1989)
W.S. Thompson et al.
Endopthalmitis after penetrating trauma. Risk factors and visual acuity outcomes
Ophthalmology
(1995)
J.T. Thompson et al.
The national eye trauma systeminfectious endophthalmitis after penetrating injuries with retained intraocular bodies
Ophthalmology
(1993)
T.A. Meredith et al.
Vancomycin levels in the vitreus cavity after intravenous administration
Am J Ophthalmol
(1995)
R.G. Ariyasu et al.
Microorganisms cultured from the anterior chamber of ruptured globes at the time of repair
Am J Ophthalmol
(1995)
W.F. Mieler et al.
Retained intraocular foreign bodies and endophthalmitis
Ophthalmology
(1990)

R.E. Foster et al.

Useful visual outcomes after treatment of Bacillus cereus endophthalmitis

Ophthalmology

(1996)

M.S. Kreslof et al.