Acute-onset endophthalmitis after clear corneal cataract surgery (1996-2005)

Purpose: To report the clinical features, causative organisms, and visual acuity outcomes associated with endophthalmitis after clear corneal cataract surgery and to compare outcomes with those of the Endophthalmitis Vitrectomy Study (EVS). Design: Retrospective consecutive case series. Participants: The study included 73 eyes of 73 patients, mean age 76 years (range, 48-94 years), with endophthalmitis after clear corneal cataract surgery, including both referred and in-house patients. Methods: The clinical and microbiology records were reviewed of all patients treated at a single medical center between January 1, 1996, and December 31, 2005, for clinically diagnosed, culture-positive endophthalmitis occurring within 6 weeks of clear corneal cataract surgery. Main Outcome Measures: Presence of hypopyon, mean time to endophthalmitis diagnosis, organisms cultured, and presenting and final visual acuities. Results: The mean time between cataract surgery and diagnosis of endophthalmitis was 13 days (median, 9 days; range, 1-39 days). Visual acuity at the time of diagnosis was < 5/200 in 61 of 73 (83.6%) patients, including light perception in 11 of 73 (15.1 %). Hypopyon was present in 60 of 73 (82.2%) eyes. The initial treatment included intravitreal vancomycin, ceftazidime, and dexamethasone. A vitreous tap and intravitreal injection was performed in 54 of 73 (74.0%) eyes and pars plana vitrectomy in 19 of 73 (26.0%) eyes. Coagulase-negative Staphylococcus was isolated in 50 of 73 (68.4%) eyes. Other isolates included Staphylococcus aureus in 5/73 (6.8%) and Streptococcus species in 6 of 73 (8.2%). A visual acuity of >= 20/40 was achieved in 36 of 73 patients (49.3%) at final follow-up. Conclusions: The features and outcomes of endophthalmitis associated with clear corneal cataract surgery are similar to those reported in the EVS, which are associated with scleral incisions, but time to diagnosis was later with clear corneal incisions.