[Features of treatment of acute postoperative endophthalmitis].

Abstract

Purpose: The purpose of this study was to analyze the outcomes of treatment of acute postoperative endophthalmitis and verify its main causative agents.

Material and methods: The study included 49 patients (49 eyes) with acute postoperative endophthalmitis that developed following surgical interventions in various clinics. At the onset of endophthalmitis, 3 patients (6.1%) retained object vision with visual acuity ranging from 0.05 to 0.20, while 7 patients (14.3%) had visual acuity between 0.01 and 0.05. Visual acuity deteriorated to finger counting near face in 15 patients (30.6%), to 1/∞ pr.l.certa in 21 patients (42.9%), and to 1/∞ pr.l.incerta in 3 patients (6.1%).

All patients were treated using a new technique we developed, which involved short-term tamponade of the vitreous cavity with perfluorodecalin and intravitreal administration of antibiotics. Before treatment start, biological material was collected for bacteriological examination.

Results: Visual function was preserved in 46 patients (93.9%). Clinically significant improvement in visual acuity (0.3-0.4) was observed in 36 patients (73.5%), while 6 patients (12.2%) achieved visual acuity greater than 0.5. No cases of recurrent inflammation were recorded; however, laser tyndallometry indicated a persistent disruption of the blood-ocular barrier for up to 6 months post-treatment, with a protein flow value of 14.6 (8.4; 19.2) ph/ms (p=0.002).

The most informative method for identifying the etiological cause of endophthalmitis was vitreous sampling (81.6% effectiveness), compared to anterior chamber sampling (38.8% effectiveness).

Conclusion: The best functional outcomes were achieved in patients with endophthalmitis caused by S. epidermidis and S. aureus. Endophthalmitis caused by gram-negative bacteria had a poor visual prognosis.