Delayed-onset endophthalmitis in patients with open globe injuries

Endophthalmitis infections generally result in poor visual outcomes after an open-globe injury. (Image Credit: AdobeStock/Siniehina)

Julia Hudson, MD, and colleagues from the Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, reported that endophthalmitis infections generally result in poor visual outcomes after an open-globe injury. In addition, delayed-onset endophthalmitis can develop in patients who sustained open globe injuries despite injection of intravitreal antibiotics at the end of the corrective surgery because of zone 1 wound leaks and infections.¹

The researchers undertook a retrospective, comparative, consecutive case series of patients with endophthalmitis after open globe injury. The study period ranged from January 2016 to October 2020, and was conducted at the Bascom Palmer Eye Institute.

Analysis of the cases showed that acute-onset endophthalmitis occurred in 16 of the 20 study cases, all of which were diagnosed at the initial examination.

Four of the 20 cases developed delayed-onset infections, which occurred more than 2 weeks after the injury, and they resulted from zone 1 wound leaks and infections.

The researchers reported that the factors associated with endophthalmitis included a retained intraocular foreign body in 11 cases and a delay in the seeking of medical help, defined as longer than 24 hours, in 15 cases (P < 0.001 and P = 0.002, respectively).

The mean best-corrected visual acuity at the initial presentation was 1.64 logarithm of the minimum angle of resolution (logMAR) (20/800 Snellen), and that at the last follow-up examination logMAR (20/300 Snellen).

The authors reached the following conclusion. “In patients with open globe injury–related endophthalmitis, visual acuity outcomes are generally poor. Despite intravitreal antibiotics administered at the primary closure, delayed-onset endophthalmitis may develop in the setting of compromised zone 1 wound integrity,” they said.

Reference:

1. Hudson JL, Fan JC, Smiddy WE, et al. Acute- and delayed-onset endophthalmitis after open globe injuries: Clinical features and visual acuity outcomes. Retina. 2023;43:594-9; DOI:m10.1097/IAE.0000000000003707