Elsevier

Ophthalmology

Volume 111, Issue 11, November 2004, Pages 2015-2022
Ophthalmology

Original article
Post-traumatic endophthalmitis

Data previously presented in part at: Royal Australian and New Zealand College of Ophthalmologists annual scientific meeting, November, 2001; Adelaide, Australia.
https://doi.org/10.1016/j.ophtha.2003.09.041Get rights and content

Abstract

Objective

To establish risk factors for the occurrence of post-traumatic endophthalmitis, to observe the efficacy of prophylaxis, and to describe the clinical features of post-traumatic endophthalmitis.

Design

Partially prospective consecutive case–control study.

Participants

A total of 250 consecutive patients admitted to a single ophthalmic hospital with open globe injuries during a 3-year period were included.

Methods

Patients with post-traumatic endophthalmitis were identified prospectively and added to an endophthalmitis database. All open globe injuries during the same time period were identified through a retrospective search of inpatient admissions, and their charts were reviewed. Information collected from all patient files included patient age; gender; injury setting (indoor/outdoor); wound contamination; nature of injury (site on eye, lens involvement, retained intraocular foreign body); mechanism of injury (penetration/perforation/rupture/ruptured surgical wound); prophylactic antibiotic administration, including route and timing; timing of primary repair; lensectomy at the time of primary repair; and depot corticosteroid at the time of primary repair. Any association between these parameters and the subsequent development of endophthalmitis was investigated. Any association between endophthalmitis and final visual acuity (VA) and also enucleation was evaluated.

Main outcome measure

Development of endophthalmitis.

Results

The frequency of endophthalmitis after open globe injury was 6.8%. The following factors were associated with the subsequent development of endophthalmitis by univariate analysis: dirty wound (14.3% vs. 4.1%, P = 0.01), retained intraocular foreign body (13.0% vs. 4.4%, P = 0.02), lens capsule breach (12.8% vs. 3.2%, P = 0.01), delayed primary repair (≥12 hours) (11.3% vs. 2.9%, P = 0.02), and rural address (10.1% vs. 4.3%, P = 0.07). Risk factors identified after multivariate analysis were dirty injury (odds ratio [OR], 5.3; 95% confidence interval [CI)], 1.5–18.7), breach of lens capsule (OR, 4.4; 95% CI, 1.2–15.6), and delay in primary repair (per hour: OR, 1.013; 95% CI, 1.002–1.024). None of the following factors was found to be associated with post-traumatic endophthalmitis: patient age, gender, injury setting, site of injury on eye, mechanism of injury, antibiotic administration, lensectomy at the time of primary repair, and depot corticosteroid at the time of primary repair. Final VA tended to be worse in eyes with endophthalmitis (P = 0.08). Endophthalmitis did not significantly influence the frequency of enucleation/evisceration (5.9% vs. 4.3%, P = 0.55).

Conclusions

Delay in primary repair, ruptured lens capsule, and dirty wound were each independently associated with the development of post-traumatic endophthalmitis. Patients with ≥2 of these 3 risk factors had a particularly high frequency of infection.

Section snippets

Materials and methods

During the 3-year period January 1, 1998 to December 31, 2000, records of all patients prospectively identified to have post-traumatic endophthalmitis and treated at the Royal Victorian Eye and Ear Hospital, Melbourne, Australia, were added to a database. The diagnosis was based on the balance of clinical features and investigation results. Those cases felt to be infectious endophthalmitis by the managing retinal surgeon and added to the endophthalmitis database were regarded as post-traumatic

Results

During the 3-year study period there were 264 cases of open globe injury. In 6, there was insufficient information in the medical file for the cases to be included in the study. Seven patients underwent primary enucleation within 24 hours of their injury, and their cases have been excluded from the analysis, as it was not possible to say whether they would have developed endophthalmitis. This left a total of 251 open globe injuries in 250 people (1 bilateral blast injury) for analysis.

There

Discussion

Defining post-traumatic endophthalmitis is problematic. There are several published reports of case series.1, 5, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17 Some are limited to culture-positive cases, whereas others include culture-negative cases. Excluding culture-negative endophthalmitis would decrease the chance of eyes with traumatic uveitis being inappropriately included, but may miss some truly infected, although culture-negative, cases. Positive cultures do not always correlate with

Acknowledgements

The authors thank Dr Mary Jo Waters of the Department of Microbiology, St Vincent's Hospital, Melbourne, Australia, for assistance with microbiologic analysis and contributions to the article's content, and Dr J. Anderson for invaluable statistical advice and assistance.

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