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   Table of Contents      
EDITORIAL
Year : 2003  |  Volume : 51  |  Issue : 2  |  Page : 117-118

National endophthalmitis survey


Correspondence Address:
T Das


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Source of Support: None, Conflict of Interest: None


PMID: 12831139

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How to cite this article:
Das T. National endophthalmitis survey. Indian J Ophthalmol 2003;51:117-8

How to cite this URL:
Das T. National endophthalmitis survey. Indian J Ophthalmol [serial online] 2003 [cited 2019 Aug 24];51:117-8. Available from: http://www.ijo.in/text.asp?2003/51/2/117/14719

Endophthalmitis is a tragic occurrence, be it after an intraocular surgery or following trauma. With this event the hopes of the patient vanish, and the confidence of the operating surgeon is shattered. Today many eyes can be saved with the timely institution of appropriate therapy. The diagnosis of endophthalmitis is always clinical. This is usually characterised by lid oedema, pain, conjunctival congestion, cells-flare-hypopyon or exudates in the anterior chamber, and vitreous cells. Indirect ophthalmoscopy in eyes with relatively clear media, and ultrasonography in eyes with hazy media complement the diagnosis. The treatment always begins with the clinical diagnosis before the final proof arrives with a positive culture of the vitreous sample. While the culture is not always positive, all agree that institution of early therapy is the most important key to success.

When the outcome is so dependent on early diagnosis, what is it that delays the diagnosis? Is it the lack of suspicion or the lack of acceptance? It is true that all eyes with many of the above mentioned clinical features may not have endophthalmitis,[1] but failure to recognise early is likely to cause severe harm to the eye. While occurrence of endophthalmitis following an intraocular surgery could mean a breach in the standard of care, inability to diagnose and treat promptly amounts to neglect of the standard of care. The latter is more grievous.

Endophthalmitis research over the years has taught us that povidone iodine pre-treatment of the conjunctiva is the most important prophylaxis,[2] that acute bacterial postcataract endophthalmitis does not need systemic antibiotics, [3] and that implementation of the Endophthalmitis Vitrectomy Study (EVS) recommendations leads to substantial national savings.[4] Such research is possible only when we record all cases of clinical endophthalmitis, meticulously document the clinical details, investigate painstakingly, and finally analyse them to design a region-specific treatment strategy. The published reports from south India have shown that the microbiological spectrum of postoperative endophthalmitis is different in south India, [5],[6] and the current issue of the Journal publishes a report from north India.[7]

While these isolated reports are important, they cannot by themselves clarify the epidemiology of endophthalmitis in India. National surveys of post cataract surgery endophthalmitis are reported from the Northern America and Western Europe. [8],[9],[10],[11],[12],[13] Such studies have helped the said countries understand the microbiology and antibiotic sensitivity pattern, and identify the risk factors of infection. In India, as is the case with several other diseases, we do not have national level data. What prevents us from acquiring it? The desire and determination to some extent, but mostly organised planning is lacking. Isn't it time that we have such a survey for the country for both post-surgery and post-trauma endophthalmitis?

We propose that the Indian Journal of Ophthalmology take a lead in this direction. You will find a response card in this issue of the journal to obtain your agreement and consent. This card is not post paid, and that the readers are expected to affix the desired denomination postage stamp is likely to demonstrate some serious desire on the part of the respondent. Once we receive your consent we will send you the data collection sheets. These information will be collected prospectively in three phases - the first report will be the information of the initial presentation, and the outcome survey will be collected twice, one month and three months later. We understand that all the patients will not be managed by the primary surgeon or at the primary location. Since all the collected information will be entered into the database and each patient's data alphabetically numbered we will be able to track the final outcome of the affected eyes, and thus avoid any duplication. Anonymity will be maintained in every step. The patient you report need not be your own case. The data thus collected will constitute a goldmine of information and can be utilised by policymakers for future planning and preparing the guidelines for the first Indian standard of care for patients with endophthalmitis. Needless to say, the data will be treated as the most privileged information by the Indian Journal of Ophthalmology and the All India Ophthalmological Society. They will be used for publication and preparing the management guidelines of endophthalmitis. Finally, such an exercise could be the basis of a future national registry on endophthalmitis.

We look forward to your support and cooperation!

 
  References Top

1.
Jalali S, Das T, Gupta S. Presumed noninfectious endophthalmitis after cataract surgery. J Cataract Refract Surg 1996;22:1492-97.  Back to cited text no. 1
[PUBMED]  [FULLTEXT]  
2.
Speaker MJ, Menikoff JA. Prophylaxis of endophthalmitis with topical povidone- iodine. Ophthalmology 1992;98:1769-75.  Back to cited text no. 2
    
3.
Endophthalmitis Vitrectomy Study Group. Results of the endophthalmitis study group. A randomized trial of immediate vitrectomy and of intraocular antibiotics for the treatment of post-operative bacterial endophthalmitis. Arch Ophthalmol 1995;113:1479-96.  Back to cited text no. 3
[PUBMED]  [FULLTEXT]  
4.
Wisniewski SR, Hammer ME, Grizzard WS, Kelsey SF, Everett D, Packo KH, et al. An investigation of the hospital charges reltaed to the treatment of endophthalmitis in the endophthalmitis vitrectomy study. Ophthalmology 1997;104:739-45.  Back to cited text no. 4
[PUBMED]  [FULLTEXT]  
5.
Kunimoto DY, Das T, Sharma S, Jalai S, Majji AB, Gopinathan U, et al. Microbial spectrum and susceptibility of isolates. Part I. Post-operative endophthalmitis. Am J Ophthalmol 1999;128:240-42.  Back to cited text no. 5
    
6.
Anand AR, Therese LK, Madhavan HN. Spectrum of aetiological agents of postoperative endophtalmitis and antibiotic susceptibility of bacterial isolates. Indian J Ophthalmol 2000;48:123-28.  Back to cited text no. 6
    
7.
Gupta A, Gupta V, Gupta A, Dogra MR, Pandav SS. Spectrum and clinical profile of post cataract surgery endophthalmitis in North India. Indian J Ophthalmol 2003;51:139-45.  Back to cited text no. 7
    
8.
Javitt JC, Vitale S, Canner JK, Street DA, Krakauer H, McBean M, et al. National outcomes of cataract extraction. Endophthalmitis following in-patient surgery. Arch Ophthalmol 1991;109:1085-89.  Back to cited text no. 8
    
9.
Javitt JC, Street DA, Tielsch JM, Wang Q, Kolb MM, Schein O, and Cataract Patient Outcome Research Team. National outcomes of cataract extraction. Retinal detachment and endophthalmitis after out-patient cataract surgery. Ophthalmology 1994;101:100-105.  Back to cited text no. 9
    
10.
Fisch A, Salvanet A, Prazuck T, Forestier F, Gerbaud L, Coscas G, et al. Epidemiology of infective endophthalmitis in France. The French Collaborative Study Group on Endophthalmitis. Lancet 1991;338:1373-76.  Back to cited text no. 10
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11.
Norregaard JC, Thoning H, Bernth-Petterson P, Anderson TF, Javitt JC, Anderson GF. Risk of endophthalmitis after cataract extraction: Results from the International Cataract Surgery Outcome Study. Br J Ophthalmol 1977;81:102-6.  Back to cited text no. 11
    
12.
Schmitz S, Dick HB, Krummenauer F, Pfeiffer N. Endophthalmits in cataract surgery: Results of a German survey. Ophthalmology 1999;106:1869-77.  Back to cited text no. 12
[PUBMED]  [FULLTEXT]  
13.
Versteegh MF, Van Rij G. Incidence of endophthalmitis after cataract surgery in the Netherlands: Several surgical techniques compared. Doc Ophthalmol 2000;100:1-6.  Back to cited text no. 13
[PUBMED]  [FULLTEXT]  



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