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

摘要

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.