• Aurélie Combey de Lambert, Nelly Campolmi, Pierre-Loic Cornut, Florent Aptel, Catherine Creuzot-Garcher, Christophe Chiquet, and French Institutional Endophthalmitis Study Group.
• Department of Ophthalmology, Université Joseph Fourier-Grenoble 1, Grenoble France2Department of Ophthalmology, University Hospital, Grenoble, France.
• JAMA Ophthalmol. 2013 Sep 1; 131 (9): 1159-66.

ImportanceAlthough rare, postoperative endophthalmitis in patients undergoing cataract surgery can lead to anatomical or functional loss of the eye. Therapeutic strategies such as antibiotic prophylaxis and microbiological diagnosis are more effective with a target patient population. New prospective data are needed to identify prognostic factors.ObjectiveTo identify baseline factors of visual prognosis in patients with acute bacterial endophthalmitis after cataract surgery.DesignProspective study of consecutive patients undergoing cataract surgery, enrolled from March 1, 2004, through December 31, 2005. We analyzed outcomes to determine the effect on the final visual outcome, defined as poor (visual acuity [VA] worse than 20/100) or good (VA 20/40 or better) using univariate and multivariate analysis.SettingFour academic hospitals.ParticipantsNinety-nine consecutive patients with cataract.InterventionCorneal phacoemulsification.Main Outcomes And MeasuresFactors related to the cataract surgery (complications), initial clinical presentation, and microbiological diagnosis and the final VA.ResultsThe significant baseline factors (at presentation) for good visual outcome (45% of the series) were the winter season, absence of complications during cataract surgery, initial VA, microbiological investigations revealing no microorganism or a coagulase-negative Staphylococcus species (CNSP), and fundus visibility. Quantitative factors associated with a good clinical prognosis were shorter duration of cataract surgery, younger age, and a hypopyon no greater than 1.5 mm. Significant factors associated with poor visual outcome were infection of the right eye, initial VA, corneal edema, a hypopyon larger than 1.5 mm, detection of bacterial species other than a CNSP, and the absence of fundus visibility. Multiple logistic regression analysis showed that high bacterial virulence was the only independent factor (odds ratio, 14.0 [95% CI, 2.7-71.0]; P = .001) for poor visual outcome. On the other hand, low bacterial virulence (odds ratio, 0.2 [95% CI, 0.03-0.6]; P = .01) and the absence of complications during cataract surgery (0.1 [0.01-0.4]; P = .003) were independent factors for good VA.Conclusions And RelevanceMost clinical outcome factors in acute postoperative endophthalmitis can be identified at presentation. The bacterial virulence level is the main factor predictive of the final visual prognosis.

46 keywords...

hide…