Clinico-microbiological profile of post-cataract surgery endophthalmitis and role of polymerase chain reaction in the management: A report from Eastern India.

Abstract

Purpose: To study the clinical and microbiological profile of post-cataract surgery endophthalmitis and assess the utility of eubacterium and panfungal polymerase chain reaction (PCR).

Methods: This was a case series of consecutive post-cataract surgery endophthalmitis patients treated at a tertiary care center in eastern India between January 2015 and December 2023. Data on clinical features, investigations, treatment, and outcomes were obtained from medical records. Aqueous or vitreous samples were first analyzed with various stains, including Gram's stain, 10% potassium hydroxide (KOH) mount, Giemsa stain, and Ziehl-Nielsen stain. Further samples were inoculated into cultures. All samples were analyzed with polymerase chain reaction (PCR) to identity eubacterium, panfungal, and Propioniobacterium acnes genomes. Favorable anatomical and functional outcomes were defined as clear media and attached retina and best-corrected visual acuity of 20/200 or better, respectively. The main outcome measure was defined as anatomical and functional outcomes in culture-negative but PCR-positive and negative cases. Chi-square tests were performed for statistical analysis, and a P value of less than 0.05 was considered significant.

Results: A total of 132 patients were included. Culture was positive in 51 (38.6%) eyes. Gram-negative bacilli (27; 51.9%) were the predominant microorganisms, with Pseudomonas aeruginosa (11; 21.1%) being the most common isolate. Eubacterium or panfungal PCR were positive in 108 (81.8%) eyes. Among 81 culture-negative patients, 57 had positive PCR results (Group A), and 24 had negative PCR results (Group B). A favorable anatomical outcome was achieved in 51 (76.1%) patients in Group A and 10 (71.4%) in Group B (P = 0.69). A favorable functional outcome was achieved in 50 (74.6%) patients in Group A and 9 (64.3%) patients in Group B (P = 0.44).

Conclusion: PCR positivity was higher than conventional culture. Eubacterium and panfungal PCR help in prompt decision-making in culture-negative endophthalmitis.