|Year : 1984 | Volume
| Issue : 6 | Page : 501-503
Endophthalmitis after cataract surgery
SS Grewal, RK Grewal, AS Gill
654, Gurudev Nagar, Ludhiana, India
S S Grewal
654, Gurudev Nagar, Ludhiana
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Grewal S S, Grewal R K, Gill A S. Endophthalmitis after cataract surgery. Indian J Ophthalmol 1984;32:501-3
Endophthalmitis is an inflammatory response to bacterial, fungal or parasitic invasion of the eye or a toxic reaction to non-replicating stimuli, occurring s a complication of cataract extraction, filtering procedures, and eye injuries. In endophthalmitis dense intravitreal opacities are produced by severe inflammation of the posterior uveal tract and retina; which may produce tissue necrosis.
Incidence of endophthalmitis is very low in western literature (0.08 -0.02%), which they felt was due to prophylactic preoperative use of antibiotics, and aseptic procedures. There has been no Indian report of incidence of endophthalmitis after cataract extraction, as for as we know. Present study showed an incidence of 2.4% 24 cases after 1000 cataract extractions in the last 2 years.
| Material and methods|| |
The 24 cases of endophthalmitis seen by us after 1000 cataract surgeries in the hospital and eye camps, were suspected to be bacterial and non replicating types of endophthalmitis. In most of the cases the reaction was more like non-replicating endophthalmitis but the incubation period resembled bacterial endophthalmitis as the majority of our cases manifested between the third and fifth days These patients were treated in the hospital. The intensity of endophthalmitis was gauged from the intensity of signs and symptoms and the red reflex and vision
a) Red reflex with ophthalmoscope and slit lamp (moderate degree).
b) Red reflex with slit lamp only (severe degree).
c) Red reflex absent with slit lamp and ophthalmoscope (very severe).
Laboratory procedures to confirm diagnosis included (1) lid margin and conjunctival cultures, (2) culture of infected bleb, conjunctival flap, or corneal wound, (3) smears of exudates from infected areas, and vitreous tap for culture and staining.
In 8 of our cases vitreous taps were done; all results proved to be negative. Conjunctival smears postoperatively from the conjunctival sac were also negative. It could be that our laboratory techniques were not perfect; otherwise also, it is very difficult to get positive results in all cases. Forster  reported positive culture in 34 out of the 140 endophthalmitis cases.
As all our cultures and smears were negative, the treatment was empirical. For the purpose of treatment given 24 cases of endophthalmitis were divided into 3 groups of 8 each as given in [Table 1].
| Observations and discussion|| |
Treatment was started soon after the case was diagnosed. The results of our treatment regimes are given according to the severity of the case [Table 2].
Out of the 24 eyes. 23 eyes were saved and one went phthisical. 11 eyes had useful] vision ranging from 6/9 to 6/60.
As to which method was the best of the 3 groups-it was found that treatment with group I was better if the severity of endophthalmitis was moderate. While in severe cases treatment in group III seemed to be better. In very severe cases, group It gave a good result where one case got 6/9 vision; whether it was coincidental or not, is conjectural. Intravitreal injection did not show any superiority over other methods. If this was really a better method, with better concentration of steroids and antibiotics in vitreous, it should have improved the conditions. This shows that increase in concentration in the vitreous is not of much importance and there may be other factors causing endophthalmitis to proceed unabated There may be tissue resistance virulence of the organisms, or antibiotic resistance or other factors typical to vitreous. Vitrectomy was not tried in any case.
Our figure of 2.4% may seem quite high as compared to the western figures and ophthalmologists might think something amiss with our techniques or sterilization; but probably, our greater awareness of the diseases led us to detect and treat these cases Every case whether in the eye camps or in the hospital were examined for the red reflex from the first day onwards. The patient's eye may look quiet with the torch light and probably would have been discharged but for our meticulous fundus examination in all cases. One will be surprised to note 2-3 such cases in every hundred cases. We have tried all methods of sterilization, irrigating solutions and hot air and we have cultured the swabs from the nails and nose of surgeons and assistants and none of these cultures were positive. We can venture only a guess that our non sterile air or some foreign material from instruments such as rust or polish or chemical used to clean the instruments are responsible; or possibly, some of the cases could be an endogenous toxic reaction to some septic focus in the body or possibly some of the cultures have failed to yield the positive results.
In conclusion, one would say that endophthalmitis is still a bed bug of ophthalmic surgeons in spite of all recent advances in drugs and surgical techniques.
| References|| |
Forster, R. K., Abbott, R. L., Gelender, H. 1980, Ophthalmol. (Rochester) 87 : 313.