[Vitrectomy for endophthalmitis after cataract surgery].

Purpose: To identify risk factors of poor visual outcome with vitrectomy for early-onset endophthalmitis after cataract surgery.

Patients And Methods: Clinical records of 29 consecutive eyes with endophthalmitis developing within 6 weeks after cataract surgery and that underwent therapeutic vitrectomy between June 1996 and April 2001 were retrospectively reviewed. Twenty-two of the eyes received intravitreal injections of vancomycin and ceftazidime at the time of vitrectomy, and all patients received intravenous antibiotics. Eyes were divided into two groups; group A consisted of 22 eyes with a final visual acuity of 0.2 or greater, and group B consisted of 7 eyes with a final visual acuity of less than 0.2.

Results: Fifteen eyes (52%) in group A achieved a visual acuity of 0.5 or better and 8(28%) achieved a visual acuity of 1.0, while 4 eyes in group B developed phthisis bulbi. For eyes with a preoperative visual acuity of hand motions or worse, there was no correlation between final visual acuity and preoperative visual acuity. The overall culture-positive rate was 57%. In group A, methicillin-resistant Staphylococcus epidermidis was identified in 6 eyes, methicillin-resistant Staphylococcus aureus (MRSA) in 3 eyes and enterococcus in 2 eyes. In group B, alpha-hemolytic streptococcus (AHS) was identified in 4 eyes, aspergillus in 1 eye, and MRSA in 1 eye. All isolates were sensitive to vancomycin with the exception of the aspergillus. AHS infection appeared to be associated with wound failure from the initial cataract surgery and a poor visual outcome. Among 3 of the eyes that developed phthisis bulbi, intravitreal injection of antibiotics was not performed.

Conclusion: Early vitrectomy and intravitreal injection of vancomycin may improve visual outcomes, but infection with AHS may be associated with cataract surgery wound failure and poor visual outcomes.