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Background and Objective: The purpose of this study was to evaluate the utility of routine bacterial and fungal cultures in the diagnosis of endophthalmitis and in the subsequent management of patients following penetrating ocular trauma., Patients and Methods: The medical records of 70 consecutive patients with penetrating ocular trauma for whom intraoperative bacterial and fungal cultures had been obtained from the wound, aqueous, vitreous, and/or intraocular foreign body (IOFB) were retrospectively reviewed. The incidences of infection among eyes with and without a clinical diagnosis of infection were compared. A determination as to change in clinical management (change of antibiotic, length of treatment) was made., Results: Twenty of 70 patients (29%) had positive cultures of the wound, aqueous, vitreous, and/or IOFB. Nine (13%) of the 70 patients were diagnosed as having endophthalmitis, based on clinical findings at presentation and during the subsequent clinical course. Seven (78%) of these 9 patients with a clinical diagnosis of endophthalmitis had positive cultures. The remaining 61 eyes showed no evidence of clinically apparent infections, despite positive cultures from 13 eyes (21%). Microbiologic data derived from the culture results influenced the clinical management of all 7 patients with endophthalmitis. Culture results (positive or negative) did not alter clinical decisions in eyes without clinical evidence of infection., Conclusion: Bacterial or fungal cultures obtained from the eye in the setting of penetrating trauma often had growth of organisms without clinical signs of infection. Positive culture results directly influenced management decisions in cases with clinically evident endophthalmitis. However, routine intra-operative bacterial cultures did not help to identify patients in whom endophthalmitis would develop, nor did they assist in directing management decisions in eyes without clinical suspicion of infection.

Purpose: To review the treatment and outcomes of patients presenting with concurrent endophthalmitis and retained lens fragments after phacoemulsification., Methods: A retrospective chart review was conducted on patients presenting with culture-proven endophthalmitis and retained lens fragments after phacoemulsification between 1990 and 1994., Results: Five patients were identified with culture-proven endophthalmitis and retained lens fragments after phacoemulsification. In all patients, coagulase-negative staphylococci were cultured from the vitreous fluid. One patient also had positive cultures for Proteus mirabilis and Escherichia coli. The interval between cataract surgery and treatment ranged from 5 days to 6 months. Echography was beneficial in showing retained lens fragments in five of five patients when media opacities obscured the view of the fundus. Four patients had vitrectomy and removal of retained lens fragments during their initial treatment. The fifth patient was treated with intravitreal antibiotics alone and continued to have marked inflammation, eventually requiring vitrectomy for removal of the retained lens fragments. A final visual acuity of 20/400 or better was achieved in four of the five patients., Conclusions: Patients may present with endophthalmitis in the setting of retained lens fragments after phacoemulsification. In such cases, the preferred initial management may be pars plana vitrectomy, removal of retained lens fragments, and injection of intraocular antibiotics. In eyes with endophthalmitis and opaque media, echography is a useful screening modality.

Purpose: Bacillus cereus endophthalmitis occurring after penetrating ocular trauma has been almost always associated with a poor visual outcome. The purpose of our study was to review and report patients who had useful visual acuity outcomes., Methods: The study group consisted of five patients from a single medical center with penetrating ocular trauma and endophthalmitis caused by B. cereus. The study population was derived from a review of the microbiology records, clinical records, and operative reports of patients with culture-proven, post-traumatic endophthalmitis over a 15-year period. Patients were only included if the final visual acuity outcomes were 20/200 or better., Results: All five patients had penetrating ocular injuries, and four patients had a retained intraocular foreign body. Endophthalmitis was diagnosed preoperatively in three patients and intraoperatively in two patients. All patients underwent pars plana vitrectomy and injection of intravitreal and periocular antibiotics. Postoperatively, a rhegmatogenous retinal detachment developed in three patients between 4 weeks and 12 months after the injury (average, 19 weeks); all retinal detachments were reattached with additional vitreoretinal surgery. Final postoperative visual acuities were 20/200 (two patients), 20/30 (one patient), and 20/25 (two patients). The postoperative follow-up time interval ranged from 12 months to 30 months (average, 19.2 months)., Conclusion: The current series adds further support to the observation that certain eyes with post-traumatic B. cereus endophthalmitis may be associated with preservation of anatomic integrity and restoration of useful visual acuity.

Purpose: To identify clinical characteristics that were associated with an increased incidence of endophthalmitis in eyes with penetrating ocular trauma., Methods: In part 1, a retrospective analysis was performed on 258 consecutive patients with penetrating ocular trauma presenting to the Bascom Palmer Eye Institute between October 1987 and January 1991. In part 2 of the study, 28 consecutive patients with culture-proven endophthalmitis were identified from the Clinical Microbiology Registry from April 1987 through September 1987 and February 1991 through August 1993. Clinical variables were evaluated in each part for association with an increased risk of endophthalmitis., Results: In part 1 of the study, endophthalmitis developed in 13 (5%) of the 258 patients. Endophthalmitis did not occur in eyes that had blunt injury. In those eyes with a lacerating injury, there was an increased relative risk of infection in eyes with disruption of the crystalline lens. This risk factor was found statistically significant by univariate and multivariate analysis. In part 2 of the study, lens disruption was present in 24 (86%) of 28 patients with culture-proven endophthalmitis. Of the 41 patients with infection from part I and part II, 22 (54%) achieved visual acuity of 20/ 400 or greater. Endophthalmitis caused by coagulase-negative staphylococci had the best visual outcome, with 7 (64%) of 11 patients obtaining visual acuity of 20/ 400 or greater., Conclusion: Lens disruption in eyes with penetrating trauma is a significant risk factor for the development of endophthalmitis. The prognosis for useful vision in eyes with posttraumatic endophthalmitis is best when infection is caused by less virulent organisms.

Purpose: Eyes with concurrent endophthalmitis and retinal detachment usually have a poor anatomic and visual outcome after treatment. The purpose of this study is to define the relation among the causative organism, the results of retinal detachment repair, and the final visual acuity., Methods: Data were retrieved by a retrospective, computer-assisted review of the coded inpatient diagnoses from April 1987 through March 1992., Results: This study included 16 patients (9 males, 7 females) ranging in age from 5 to 88 years (average, 58.7 years). Endophthalmitis was classified as exogenous in 13 (81%) patients and endogenous in 3 (19%). Two groups were identified: a virulent group that included eight (50%) patients (Staphylococcus aureus, streptococci, gram-negative, Bacillus), and a less-virulent group that included eight (50%) patients (Staphylococcus epidermidis, Propionibacterium acnes, fungal). The initial surgical procedure consisted of diagnostic vitreous fluid collection by pars plana vitrectomy (11 cases), anterior vitrectomy (1 case), or vitreous aspiration (4 cases). Additional initial adjunctive surgical procedures included pars plana lensectomy (2 cases), scleral buckling (6 cases), fluid-gas exchange (7 cases), and intraocular antibiotic injections (9 cases). In six (75%) of eight patients with endophthalmitis in the virulent group, the retina remained detached. However, in seven (88%) of eight patients with endophthalmitis in the less-virulent group, the retina remained reattached postoperatively, and the remaining patient had a stable, nonprogressive peripheral tractional retinal detachment. None of the eight patients with endophthalmitis in the virulent group retained a postoperative visual acuity of better than 3/200, and four (50%) lost all light perception. Five (62%) of the eight patients with endophthalmitis in the less-virulent group retained a postoperative visual acuity of 5/200 or better, and none lost all light perception., Conclusions: Concurrent endophthalmitis and retinal detachment patients with virulent organisms have a poor prognosis. Visual and anatomic outcomes were better in the less-virulent group.

Purpose: This article presents three patients with endophthalmitis associated with infection with Capnocytophaga species., Methods: The medical records of three patients with culture-positive Capnocytophaga endophthalmitis were reviewed. A panel of isolates of Capnocytophaga were then tested for sensitivity to third-generation cephalosporins., Results: Endophthalmitis with Capnocytophaga species developed in three patients. Infection in the setting of sepsis developed in one patient. Two other patients, one with a penetrating injury and another with keratitis in association with a corneal graft, developed mixed infection with Capnocytophaga being the predominant infecting organism by culture. Two patients recovered vision with clearance of the infection. The third patient underwent enucleation. Capnocytophaga was found to be sensitive to several of the third-generation cephalosporins. To the best of the authors' knowledge, these are the first reported cases of endophthalmitis with Capnocytophaga species., Conclusion: Capnocytophaga species, previously shown to cause necrotizing keratitis, is a potential cause of endophthalmitis, either as a single organism or as part of a mixed infection.