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Am J Ophthalmol. 2002 Jan;133(1):62-9.

Endophthalmitis after deadly-weapon-related open-globe injuries: risk factors, value of prophylactic antibiotics, and visual outcomes.

Author information

1
Department of Ophthalmology, GATA Gülhane Military Medical Academy and Medical School, Ankara, Turkey. gsobaci@gata.edu.tr

Abstract

PURPOSE:

To identify clinical and microbiologic factors influencing the prevalence and visual outcomes in endophthalmitis after deadly-weapon-related open-globe injuries.

METHODS:

In a retrospective study of 228 eyes of 212 patients with deadly-weapon-related open-globe injuries, clinical and microbiologic factors influencing the prevalence and visual outcome in endophthalmitis were analyzed in detail.

RESULTS:

Twenty-nine eyes enucleated for irreparable damages at presentation were excluded. Nineteen eyes (18 patients) of 199 (186 patients) were associated with culture-proven endophthalmitis. Presence of grade 4 injury, a variable of Ocular Trauma Classification System, and lens disruption at presentation were the significant risk factors for development of endophthalmitis (P =.001; odds ratio = 15.9 [2.0 to 122.1]), and ([P <.001; odds ratio = 17.7 [2.3 to 136.3]), respectively. Favorable outcome (visual acuity of 5/200 or better) was achieved in only four eyes (21%). Five eyes (26.3%) were phthisical, and five eyes (26.3%) were enucleated or eviscerated. All eyes were under the coverage of prophylactic intravenous antibiotics when culture positivity was obtained. Except two eyes with Acinetobactersp., all were infected by gram-positive micro-organisms (89.5%), the most common of which (42%) was Staphylococcus epidermidis. None of the clinical characteristics and treatment modalities affected final visual outcome. Favorable outcome was associated with infection by the less virulent micro-organism S. epidermidis (P =.018; odds ratio = 0.50 [0.25 to 1.00]).

CONCLUSIONS:

Endophthalmitis after deadly-weapon-related open-globe injuries has a dismal visual prognosis. Severity of injury and lens disruption are significant risk factors for development of endophthalmitis. Infection with a less virulent microbe is the only factor associated with favorable outcome.

PMID:
11755840
DOI:
10.1016/s0002-9394(01)01320-4
[Indexed for MEDLINE]

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