Abstract

P 227

Endophthalmitis: Operation procedures and long term outcome – The Mannheim experience

Florian Rensch, Frank Schlichtenbrede, Jost B. Jonas
Augenklinik, Universitätsmedizin Mannheim

Objective
The aim of this study was to distinguish which form of surgical management, either pars plana vitrectomy as first treatment or capsular bag irrigation, and which accompanying procedures lead to a favourable outcome (in terms of vision, secondary number of interventions) in patients with endophthalmitis.
Methods
Between January 2002  and May 2008 a total of 47 patients with Endophthalmitis were treated at our hospital and the data were collected retrospectively. 
80% of patients presented with acute onset (up to 1 week following sugery), the remainder ranged from 10 days to 10 months postoperatively.
85.1% of the procedures were cataract surgery (phacoemulsification only), the remainder post goniotrepanation (5.9%) intravitreal injection (6.9%) oder endogenous (2.1%).
Results
70.2% of patients required only one intervention. The majority of patients (78.7%) were treated with pars plana vitrectomy plus administration of intravitreal antibiotics. Only 9 patients (24.3%) of this group needed further surgery for persisting symptoms and continuous inflammatory cells in the anterior chamber or vitreous body. When silicone oil was used (n=15), this figure was even slightly lower at 20%, but paid for with the disadvantage of the need for silicone oil removal.
Using capsular bag irrigation in 10 patients (21.3%) , we saw 60% remission of inflammation, 40% needed further interventions.
In 74.5% useful vision was achieved (meter visual acuity). In 21.3% a vision on 0.5 or better was achieved.
The mean visual acuity in the vitrectomy group improved slightly from 0.02 ± 0.06 at baseline to 0.15 ±  0.23 postoperatively.
Visual acuity (VA) development was considerably better in the patients who underwent capsular bag irrigation with 60% achieving 0.5 or better. Mean visual acuity improved in this group from 0.17 ± 0.20 at baseline to 0.51 ±  0.30 postoperatively.
Conclusions
Capsular bag irrigation could be an alternative procedure in patients with low grade endopthalmitis producing good visual outcome. To ensure a favourable outcome a highly individual approach is required.

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