Naveenam S. Muralidhar, MD (Bangalore, India), Paul E. Tornambe, MD (Poway, CA), Hemanth Murthy, MD (Bangalore, India), Veena Hemanth, MD (Mysore, India)

PURPOSE:

Endophthalmitis due to Pseudomonas has been reported to have poor outcome. We present our results of managing this condition with good outcome.

METHODS:

A retrospective analysis of records of 16 eyes of 16 patients with acute post operative endophthalmitis following cataract surgery with intraocular lens (IOL) implantation, who tested culture positive for Pseudomonas species was done. All the patients had undergone cataract surgery elsewhere and referred for management of endophthalmitis. All the patients underwent vitreous tap with intravitreal injection of Vancomycin 1 mg and Ceftazidime 2.25 mg as the first line of treatment. Subsequently, Vitrectomy with repeat antibiotic injection or only repeat antibiotic injection was done depending upon the clinical response and the microbiological report.

RESULTS:

16 eyes of 16 patients were included in the study. There were 7 males (44%) and 9 females (56%). The mean age was 61.05 years (range 45-80 years). The median interval between IOL surgery and onset of symptoms was 5 days (range 1-12 days) and the median interval between onset of symptoms and presentation was 3 days (range from 1-18 days). Initial vision was PL only in 10/16 eyes (62.5%), Hand movements (HM) in 2 eyes (12.5%) and 3/200 in 4 eyes (25%). Final visual outcome – no PL in 2/16 eyes (12.5%)- PL only- 1/16(6%), HM in 1/16 (6%), 3/200 in 3/16(19%), 20/200 to 20/100 in 3/16 (19%), 20/60 in 2/16 (12.5%), 20/50 in 2/16 (12.5%) and 20/40 in 2/16 (12.5%) eyes. 4 eyes with vision of HM or less became phthisical. None of the eyes required evisceration. 9/16 (56%) eyes had 20/200 or better vision. All the 4 patients with poor outcome (Vision of no PL, PL and HM) did not undergo vitrectomy as the anterior segment did not permit this.

CONCLUSION:

Post cataract surgery endophthalmitis due to Pseudomonas aeruginosa scan can have good outcome provided aggressive treatment with Vitrectomy could be performed. Corneal involvement precluding vitrectomy had poor outcome.