http://www.evrs.eu/medias/2006/congress/Microbial-Isolates-and-Sensitivities-in-Posterior-segment-Intraocular-Foreign-Body-(IOFB)-Injuries:-A-10-year-Review.swf

Samuel B Barone, MD (New York, NY), Sean C. Lalin, MD (New York, NY), Mahendra Shah, MS (New York, NY), Steven A. McCormick, MD (New York, NY), Richard B. Rosen, MD (New York, NY), Ronald C. Gentile, MD (New York, NY)

PURPOSE:

Evaluate the incidence of endophthalmitis and/or microbial contamination with microbial spectrum and sensitivities in posterior-segment intraocular foreign body (IOFB) injuries.

METHODS:

A retrospective, non-comparative, consecutive case series of 80 patients with posteriorsegment IOFBs who presented to the New York Eye and Ear Infirmary between January 1995 and December 2005 was performed. All patients underwent surgical removal of the IOFB.

RESULTS:

Cultures were performed on the intraocular fluid and/or the IOFB in 49 of 80 eyes. 23 eyes had microbial contamination with 7 eyes presenting with clinical evidence of endophthalmitis. Only 9 of the 16 eyes with microbial contamination but without clinical evidence of endophthalmitis received intra-vitreal antibiotics at the time of surgery. None of the eyes developed endophthalmitis post-operatively. 80% of the isolates were gram positive. 2 isolates were anaerobic and 2 were yeast. Six cases were polymicrobial. The most common organisms isolated were coagulase-negative Staphylococcus (52.2%) followed by Bacillus Cereus (21.7%) and coagulasepositive Staphylococcus (17.4%). All the gram-positive organisms were sensitive to vancomycin. An Escherichia coli isolate was the only gramnegative organism resistant to ceftazidime.

CONCLUSION:

The incidence of microbial isolates (47%) was much greater than the rate of clinical endophthalmitis (9%) in patients who presented with posterior segment IOFB. Early vitrectomy with or without the use of intraocular antibiotics appears to prevent progression to clinical endophthalmitis. The combination of vancomycin and ceftazidime covered 96% of the microorganisms isolated.