Treatment and outcome of traumatic endophthalmitis in open globe injury with retained intraocular foreign body

Chang Sue Yang, Chao Kung Lu, Fenq Lih Lee, Wen-Ming Hsu, Yi Fen Lee, Shui Mei Lee

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

Purpose: Our aim was to evaluate the incidence, risk factors, pathogens, use of systemic and intravitreal antibiotics, and outcome of traumatic endophthalmitis after open globe injury with retained intraocular foreign body (RIOFB). Methods: Patients with open globe injury and RIOFB complicated by endophthalmitis were enrolled and retrospectively studied in Taiwan over a 20-year-period from 1981 to 2002. Results: There were 125 patients, who sustained open globe injury and RIOFB, which required surgical management. In 15 patients (12%) traumatic endophthalmitis was identified. Thirteen (87%) of these 15 cases had signs of endophthalmitis at their initial presentation. The patients' mean age was 41 years; all of them were male. Invading micro-organisms were isolated in 8 patients, and the positive culture rate was 53%. Gram-negative bacteria were the most commonly isolated organisms in 6 patients and 1 eye with multiple organisms. One eye with culture-proven Bacillus cereus had a very fulminant course and ended with phthisis bulbi. All 15 patients received topical and systemic intravenous antibiotic treatment; 9 eyes (60%) were given intravitreal antibiotic injection with broad-spectrum combined vancomycin and ceftazidime in 5 eyes. Pars plana vitrectomy was performed in 9 patients, with successful removal of RIOFB. The final visual acuity improved in 8 patients (53.5%), was unchanged in 1 (6.7%) and worse in 6 (40.0%). Five patients (33%) got a visual outcome of 6/60 or better. There were also 5 patients (33%) with a poor outcome of no light perception. Eleven (73%) of 15 patients had treatment delayed for >24 h after injury, and 5 out of these 11 patients had a very poor visual outcome (1 hand motion, 4 no light perception). Delay of presentation for >24 h after injury was associated with a tendency to increased risk of endophthalmitis [11/71 (15.5%) vs. 4/54 (7.4%)]. Conclusions: Early intravitreal antibiotics and prompt vitrectomy to remove the contaminating IOFB may salvage useful vision in some patients with traumatic endophthalmitis with RIOFB. Delay of treatment for >24 h was associated with increased risk of traumatic endophthalmitis.

Original languageEnglish
Pages (from-to)79-85
Number of pages7
JournalOphthalmologica
Volume224
Issue number2
DOIs
Publication statusPublished - Feb 1 2010

Fingerprint

Endophthalmitis
Foreign Bodies
Wounds and Injuries
Anti-Bacterial Agents
Vitrectomy
Light
Intravitreal Injections
Bacillus cereus
Ceftazidime
Temazepam
Vancomycin
Gram-Negative Bacteria
Taiwan
Visual Acuity

Keywords

  • Endophthalmitis
  • Intraocular foreign body
  • Open globe injury
  • Trauma
  • Vitrectomy

ASJC Scopus subject areas

  • Ophthalmology
  • Sensory Systems

Cite this

Treatment and outcome of traumatic endophthalmitis in open globe injury with retained intraocular foreign body. / Yang, Chang Sue; Lu, Chao Kung; Lee, Fenq Lih; Hsu, Wen-Ming; Lee, Yi Fen; Lee, Shui Mei.

In: Ophthalmologica, Vol. 224, No. 2, 01.02.2010, p. 79-85.

Research output: Contribution to journalArticle

Yang, Chang Sue ; Lu, Chao Kung ; Lee, Fenq Lih ; Hsu, Wen-Ming ; Lee, Yi Fen ; Lee, Shui Mei. / Treatment and outcome of traumatic endophthalmitis in open globe injury with retained intraocular foreign body. In: Ophthalmologica. 2010 ; Vol. 224, No. 2. pp. 79-85.
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