Antibiotic sensitivity pattern on cluster endophthalmitis caused by Gram negative organism

Abstract

Introduction: Endophthalmitis is a rare but devastating complication of intraocular surgery occurring in 0.07%-0.3% of total surgeries. With the introduction of Phacoemulsification through corneal incision, incidence of endophthalmitis has increased in recent days. Outcome of endophthalmitis is worse when it is caused by gram negative organisms.

Methods: Hospital based prospective study of cluster endophthalmitis following cataract surgery done on a single day. Surgeries were performed at BP Koirala Lions Centre of Ophthalmic Studies, IOM, Kathmandu, Nepal.

Results: 8 cases of acute endophthalmitis following cataract surgery were included in the series. Out of them 8, 87.5% (7) had isolates in the both anterior chamber and vitreous tap. Ali patients had infection due to e-coli. 4 cases had mixed growth of E.coli and Staph. aureus in vitreous and anterior chamber both 3 patients had growth of E.coli only in both vitreous and anterior chamber. And 1 patient had growth of E.coli in vitreous only. All the patients complaint of severe pain after few hours of surgery, Visual acuity in 6 patients was CFCF and 1 patient was hand movement (HM), 1 patient had perception of light only.  Intravitreal injection of vancomycin (1 mg/0.1ml) and Amikacin (0.4mg/0.1 ml) and Dexamethsone (0.4mg/0.1ml) was given in all cases after AC and Vitreous tap on the first day. On 2^nd day all patients underwent vitrectomy and intra vitreal injection repeated in half dose. Out of 8 cases, 3 (37.5%) developed RD. 1 (12.5%) had to undergo evisceration. 1 (12.5%) patients developed cornel opacity, 3(37.7%) patients has good visual recovery visual acuity of 6/6-6/36.

Conclusion: Even after aggressive treatment acute postoperative endophthalmitis due to gram negative bacteria has a bad prognosis.