Cason B Robbins1, Henry L Feng1, C Ellis Wisely1, Melissa Daluvoy1, Sharon Fekrat2. 1. Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina, USA. 2. Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina, USA. Electronic address: sharon.fekrat@duke.edu.
Abstract
PURPOSE: To describe the clinical presentation, management, and visual outcomes of 6 eyes with endophthalmitis after Descemet stripping endothelial keratoplasty (DSEK). DESIGN: Retrospective case series. METHODS: Setting: Tertiary, academic eye center. StudyPopulation: Individuals developing endophthalmitis after DSEK at the Duke Eye Center from January 1, 2009, to January 1, 2018, with at least 6 months of follow-up. ObservationProcedure: Retrospective chart review. OutcomeMeasures: Diagnostic procedures, microbiological yield, and visual outcomes. RESULTS: Six eyes of 6 patients were identified. Mean time from surgery to presentation was 51 days (range, 4-137 days). Dense vitreous opacities were present in all cases. Five of 6 cases (83%) had culture-proven infectious endophthalmitis (2 Candida glabrata, 2 coagulase-negative Staphylococcus, 1 Streptococcus pneumoniae). Aqueous tap yielded positive culture in 2 of 2 cases with adequate sample (100%); needle vitreous tap yielded positive culture in 0 of 3 cases. One eye underwent vitrectomy on presentation, and 3 eyes (50%) underwent subsequent vitrectomy for persistent endophthalmitis after a mean of 37 days. Mean pre-endophthalmitis visual acuity (VA) was 20/64; mean VA at 6 months was 20/2069 (average 15 ETDRS lines lost). VA at 6 months was light perception or no light perception in 3 of 6 cases (50%). One eye underwent enucleation at 6 months, and 1 eye became phthisical 1 year after endophthalmitis. CONCLUSIONS: DSEK-related endophthalmitis may lead to severe vision loss, even with prompt and appropriate treatment. Aqueous tap had a higher culture yield than needle vitreous tap in our series.
PURPOSE: To describe the clinical presentation, management, and visual outcomes of 6 eyes with endophthalmitis after Descemet stripping endothelial keratoplasty (DSEK). DESIGN: Retrospective case series. METHODS: Setting: Tertiary, academic eye center. StudyPopulation: Individuals developing endophthalmitis after DSEK at the Duke Eye Center from January 1, 2009, to January 1, 2018, with at least 6 months of follow-up. ObservationProcedure: Retrospective chart review. OutcomeMeasures: Diagnostic procedures, microbiological yield, and visual outcomes. RESULTS: Six eyes of 6 patients were identified. Mean time from surgery to presentation was 51 days (range, 4-137 days). Dense vitreous opacities were present in all cases. Five of 6 cases (83%) had culture-proven infectious endophthalmitis (2 Candida glabrata, 2 coagulase-negative Staphylococcus, 1Streptococcus pneumoniae). Aqueous tap yielded positive culture in 2 of 2 cases with adequate sample (100%); needle vitreous tap yielded positive culture in 0 of 3 cases. One eye underwent vitrectomy on presentation, and 3 eyes (50%) underwent subsequent vitrectomy for persistent endophthalmitis after a mean of 37 days. Mean pre-endophthalmitis visual acuity (VA) was 20/64; mean VA at 6 months was 20/2069 (average 15 ETDRS lines lost). VA at 6 months was light perception or no light perception in 3 of 6 cases (50%). One eye underwent enucleation at 6 months, and 1 eye became phthisical 1 year after endophthalmitis. CONCLUSIONS: DSEK-related endophthalmitis may lead to severe vision loss, even with prompt and appropriate treatment. Aqueous tap had a higher culture yield than needle vitreous tap in our series.
Authors: Eric J Shiuey; Nikki A Mehran; Melih Ustaoglu; Qiang Zhang; Reza Razeghinejad; Aakriti G Shukla; Natasha N Kolomeyer; Jonathan S Myers; Daniel Lee Journal: Graefes Arch Clin Exp Ophthalmol Date: 2021-09-22 Impact factor: 3.117