Endophthalmitis After Cataract Surgery: Changes in Management Based on Microbiologic Cultures

Abstract‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬ Objective To assess the utility of microbiologic culture data for the management of endophthalmitis following cataract surgery. Design Retrospective, single-center, cohort study Participants All patients treated for endophthalmitis following cataract surgery between 1/1/2014 and 12/31/2017 at a single institution. Methods Endophthalmitis cases were determined from billing records and confirmed with chart review. A change in clinical management was defined as additional intravitreal antibiotic injections or pars plana vitrectomy. Main Outcome Measures A change in clinical management within 2 weeks of initial endophthalmitis culture and treatment; visual acuity. Results A total of 111 eyes of 111 patients were treated for endophthalmitis following cataract surgery, of which 57 (51%) were culture-positive. Following initial treatment of endophthalmitis, a change in clinical management following vitreous culture occurred in 9 of 111 eyes (8%), including 6 of 57 (11%) culture-positive eyes compared to 3 of 54 (6%) culture-negative eyes (p = 0.49). Change in clinical management for culture-positive eyes was based on declining vision (3 eyes), worsening clinical exam (2 eyes), and retinal detachment (1 case). Change in clinical management for culture-negative endophthalmitis eyes was based on worsening clinical exam (2 eyes) and declining vision (1 eye). No additional interventions were initiated based on positive culture results. At final follow up, mean logMAR visual acuity was 1.09 [approximately 20/250] for the culture-positive eyes compared to 0.59 [approximately 20/80] for culture-negative eyes (adjusted difference 0.394; 95% confidence interval = 0.02 – 0.77, p = 0.03). Rhegmatogenous retinal detachments (RRD) or retinal tears occurred in 19 of 111 (17%) eyes after developing endophthalmitis, and culture-positive eyes developed a secondary RRD in 11 of 57 (19%) eyes compared to 3 of 54 (6%) culture-negative eyes (p = 0.03). Conclusion Following endophthalmitis related to cataract surgery, vitreous cultures may have prognostic value for final visual outcomes but have a limited effect on clinical management.