|Year : 1981 | Volume
| Issue : 3 | Page : 187-191
Microbiological and cytological study of aspirated ocular humours in endophthalmitis
MR Jain, Maskeen Sethi
Department of Ophthalmology, R.N.T. Medical College, Udaipur, India
M R Jain
Department of Ophthalmology, R.N.T. Medical College, Udaipur
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Jain M R, Sethi M. Microbiological and cytological study of aspirated ocular humours in endophthalmitis. Indian J Ophthalmol 1981;29:187-91
|How to cite this URL:|
Jain M R, Sethi M. Microbiological and cytological study of aspirated ocular humours in endophthalmitis. Indian J Ophthalmol [serial online] 1981 [cited 2020 Nov 30];29:187-91. Available from: https://www.ijo.in/text.asp?1981/29/3/187/30877
The aim of the study is to determine the relative incidence of the type of endophthalmitis with reference to the type of etiological agents by obtaining cultures of aspirated intraocular fluids, utilizing specific media so that rational therapy could be instituted.
| Materials and methods|| |
In the present study, 20 consecutive cases of endophthalmitis clinically appearing as of infective origin, either endogenous or exogenous type during one year period were taken.
The clinical criteria for the diagnosis of endophthalmitis were marked diminution of vision, ocular discomfort and pain, lid oedema, conjunctival chemosis and congestion, steamy or dull looking cornea and hazy anterior chamber, hypopyon, abscess cavity in vitreous, low intraocular pressure and poor to absent fundus reflex. History of trauma, surgery & corneal ulcer was also elicited.
The aqueous and vitreous humour was aspirated.
The aspirated fluid was immediately transferred to the bottles containing media for bacterial growth (glucose broth) and fungus growth (Sabouraud's agar). Also three smears on clean slides were prepared and stained with Gram's strain, Giemsa's stain and Potassium hydroxide stain. Search was also made for any focal infection.
Cultures were done on nutrient agar, blood agar and thioglycollate broth. The characterstics of culture were noted and Gram's stain & biochemical reactions were done for identification of bacteria. The innoculated media was observed for 48 hours before the culture was considered sterile. For fungus, repeated inspection was done upto 4 weeks and if any growth was suspected, then fungi were identified with lactophenol blue stain.
| Observations|| |
[Table - 1] Shows the incidence of exogenous & endogenous endophthalmitis. Incidence of males suffering from endophthalmitis was three times more frequent than females. The commonest age group was 55 plus since intraocular surgery is more frequent in this age group.
None of the cases was positive for Gram's or Giemsa's stain. One case showed evidence of fungus with 10 percent potassium hydroxide stain. Nearly half of the slides which showed abundance of polymorphonuclear cells were later on proved by culture study to have some micro organisms.
[Table - 2] depicts the presentage of positive growth in aqueous & vitreous cultures in exogenous & endogenous cases.
| Discussion|| |
Out of our endophthalmites cases, 85 percent cases were exogenous in origin resulting mostly due to trauma either operative or accidental and occasionally due to perforated corneal ulcer. Endophthalmitis following cataract surgery formed the single largest group comprising 53 percent. It was recorded that out of 1095 consecutive cataract surgery conducted 9 cases resulted in endophthalmitis giving an over all incidence of 0.45 percent while none of the cases following glaucoma surgery during that period resulted into endophthalmitis.
Injury forms second biggest factor and it3 incidence is likely to vary mainly depending upon the profession of the persons living in that particular area. Persons engaged as mechanics, masons working with chisel and hammer, farmers and children playing vigrous games constitute main subjects who are exposed to trauma and hence to endophthalmitis. In our series, 41 percent of the cases followed injury of one or other nature.
Higher incidence in male population with a ratio of 3 : 2 is mainly due to two factors. Firstly, males are more commonly employed in professions liable to injury secondly, the ratio of male to female in our cataract statistics was 2 : 1. suggesting that more males are operated for cataract.
Observation of marked diminution of vision with ocular pain or headache and signs of anterior segment inflammation in the present study are consistent with the findings of Theodore Pincus et al, and Whiston. In the endogenous variety, yellowish white opacity in the pupillary area without any anterior segment involvement were noted. In agreement with Theodore et a1 and Whiston we noticed hypopyon in 60 percent of eyes. The fundus reflex was absent in 50 percent and presence of mere red glow without any details in 40 percent and a yellowish white reflex in 10 percent of eyes. Pincus et al too reported absence of fundus glow in 60 percent & Whiston in 80 percent. Therefore it could be inferred from the present study that a dull or absent fundus reflex along w ;sub th pain are early signs and symptom of endophthalmitis.
In the present study, infecting organism has been detected and isolated in 50 percent of the cases. Aqueous aspirate gave positive results in 45 percent & vitreous in 88 percent, stressing the significance of vitreous culture in the successful management of endophthalmitis.
Out of 10 positive cases, 9 cases gave monobacterial growth and one showed two types of organisms. Incidence of gram positive and gram negative organisms were equal (48.5 percent each) while one case showed fungus epidermophyton. Available literature shows comparatively higher incidence of gram positive organisms, While some of the workers have found higher incidence of gram negative organisms Staph. aureus was found to be commonest infecting bacteria in one series and Ps. aeruginosa was found in two post traumatic cases.
Mycotic endophthalmitis has been reported by various teams of workers. Forster reported incidence of 18 percent fungal endophthalmitis in his series. We noted in 9 percent eyes but our series is too small to have statistical significance. The single case that we noted was following perforation of corneal ulcer & the fungus isolated was epidermophyton, which is not reported by any author except in corneal ulcer.
One of the observation of this study had been sterile culture in all the three cases of endogenous endophthalmitis. Detection of infecting organism in endogenous endophthalmitis has been scarely reported, with isolation of staphylococci & pneumococci.
Preponderance of polymorphonuclear leucocytes, in smears is a guide to the fact that this particular patient is likely to have positive growth. Secondly, smear with KOH is of definite significance in diagnosis of fungal infection.
| Summary|| |
The study is an attempt to correlate the clinical signs and symptoms to etiological agents and to identify the infecting organism from the aspirated humours (aqueous and vitreous) with the help of Gram's stain, Giemsa's stain, Potassium hydroxide stain and culture studies utilizing specific media. Out of the 20 consecutive cases so studied, 8.5 percent were exogenous and out of these commonest incidence was following catract surgery. Staphylococcus was the commonest organism and fungus epidermophyton not reported before was detected in one case.
| References|| |
Pincus J., Deiter P., Sears, M.L., 1965, Amer. J. Ophthalmol. 59 :403.
Whiston, G.J. 1967, Canad J. Ophthalmol. 2 : 63.
Theodore F.H., Littman, M.L., and Almeda, E., 1961. Arch. Ophthalmol, 66 : 163.
Fahmy J.A., 1975, Acta. Ophthalmol. 53 : 522.
Forster R.K., 1974, Arch. Ophthalmol 92: 387.
Peyman, G.A. and Hebst R : 1974, Arch. Ophthalmol. 91 : 416.
Burns, R.P., 1959, A. J. Ophthalmol 48 : 519.
Jain,.,M.R., Sharma, H.R., 1973, Brit. J. Ophthalmol. 57: 698.
[Figure - 1], [Figure - 2], [Figure - 3]
[Table - 1], [Table - 2], [Table - 3]