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    ACUTE-ONSET ENDOPHTHALMITIS AFTER CATARACT SURGERY Success of Initial Therapy, Visual Outcomes, and Related Factors
    (Lippincott Williams & Wilkins, 2009) Altan, Tugrul; Acar, Nur; Kapran, Ziya; Unver, Yaprak Banu; Yurttaser, Serap; Kucuksumer, Yasar; Eser, Ilker
    Purpose: To evaluate the success of initial treatment and the factors influencing the outcome in acute-onset endophthalmitis after cataract surgery. Methods: We retrospectively reviewed the medical records of all patients with acute postoperative endophthalmitis between 2000 and 2007. We performed pars plana vitrectomy (PPV) to all eyes with initial visual acuity of light perception. Eyes with visual acuity of hand motions or better underwent either intraocular antibiotic injection (IOAI) or PPV. Eyes that did not give a good clinical response to initial therapy within 60 hours underwent a second procedure. The main outcome measure was the rate of early reintervention after PPV and IOAI. Results: We evaluated 88 eyes of 88 patients. Thirty-seven patients underwent PPV and 51 patients underwent IOAI alone. Six of 37 (16.2%) patients required 1 or more procedures within 60 hours of the initial procedure in the PPV group. Twenty-eight of 51 eyes (54.9%) in the IOAI group underwent PPV within 60 hours. The rate of response to primary PPV was significantly higher than to primary IOAI (P < 0.001). Gram-negative organisms composed 35.1% of the isolates. Conclusion: Pars plana vitrectomy may be preferable to IOAI in postoperative endophthalmitis since the rate of early reintervention is lower with initial PPV. RETINA 29:606-612, 2009
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    Comparative outcomes of pars plana vitrectomy in acute postoperative endophthalmitis with 25-gauge and 20-gauge techniques
    (Springer Tokyo, 2009) Altan, Tugrul; Kapran, Ziya; Eser, Ilker; Acar, Nur; Uenver, Yaprak Banu; Yurttaser, Serap
    To evaluate the safety and outcomes of 25-gauge pars plana vitrectomy (PPV) in the treatment of postoperative endophthalmitis and compare it with 20-gauge PPV. The medical records of all patients diagnosed with acute endophthalmitis following cataract surgery who underwent PPV between December 2000 and December 2007 were reviewed. Main outcome measures included final visual acuity (VA), additional interventions, and both intraoperative and postoperative complications. Records of 70 eyes of 70 patients with a condition diagnosed as postoperative endophthalmitis were evaluated. Fifty-eight eyes underwent 20-gauge PPV (group 1), and 12 eyes underwent 25-gauge PPV (group 2). Mean follow-up time for group 1 was 9.6 +/- 8.8 months, and for group 2, 7.9 +/- 12.7 months (P = 0.57). Median VA at presentation was hand motion in both groups. The differences between the two groups in frequencies of visual outcome levels of 20/800 and 20/100 were significant in favor of group 2 (20/800, P = 0.006; 20/100, P = 0.01). In group 2, fewer additional interventions were required, and postoperative complications tended to be less frequent. Twenty-five-gauge PPV seems to be safe and effective in the management of postoperative endophthalmitis. This sutureless technique may have some advantages over 20-gauge surgery, but controlled studies are needed to confirm the results.
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    Isolates and antibiotic sensitivity of eighty culture-proven endophthalmitis cases from Istanbul
    (Karger, 2008) Eser, Ilker; Kapran, Ziya; Altan, Tugrul; Karatas, Meltem Ozel; Aydin, Derya; Okaygun, Eda; Yilmaz, Omer Faruk
    Purpose: To investigate the spectrum of organisms causing endophthalmitis and their sensitivity to commonly used antimicrobial agents. Methods: Medical records of 80 consecutive patients treated at Beyoglu Eye Hospital for endophthalmitis from January 2001 to April 2006 were reviewed. Specimens were obtained from either the vitreous (93%, 81/87) or anterior chamber (7%, 6/87) during pars plana vitrectomy or vitreous tap, and were inoculated into blood culture bottles. A Kirby-Bauer disk diffusion test was performed to determine antibiotic susceptibility. The outcome measures included isolates identified and antibiotic sensitivity of the specimens. Results: Fifty-six of 87 (64.4%) isolates were Gram-positive organisms, 29 (33.3%) were Gram-negative organisms, and 2 (2.3%) were fungi. The most common organism group identified was coagulase-negative staphylococci in 26.4% (23/87). While vancomycin was active against all Gram-positive isolates tested (100%), ceftazidime had the highest susceptibility rate (100%) for Gram-negative organisms isolated. Conclusions: Although coagulase-negative micrococci predominated in this series, a high isolation rate for Gram-negative organisms was obtained. High susceptibility rates for ofloxacin make it an alternative to ceftazidime and vancomycin in both Gram-negative- and Gram-positive-derived endophthalmitis, respectively. Studies with larger series and additional antibiotics are needed to confirm these findings. Copyright (C) 2008 S. Karger AG, Basel.
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    The Isolates in Endophthalmitis Cases Following Cataract Surgeries
    (Turkish Ophthalmological Soc, 2008) Altan, Tugrul; Acar, Nur; Unver, Yaprak Banu; Eser, Ilker; Kapran, Ziya
    Purpose: To investigate the isolates of endophthalmitis cases following cataract surgeries in a single institute. Methods: Twenty eyes of 20 patients who had the diagnosis of endophthalmitis following cataract surgeries in Beyoglu Eye Training and Research Hospital were included to the study. Mean age was 68.6 +/- 11.8 years (40-82) and 12 of them (60%) were male and 8 of them (40%) were female. Vitreous samples were sent to the laboratory for microbiological analysis in the syringe without inoculating (1 case) or after inoculation into blood culture bottles (19 cases). Results: While 16 of 19 (84.2%) blood culture bottles yielded positive, 3 of 19 remained sterile. The sample which was sent in the syringe remained sterile. Overall, 11 of 18 (61%) isolates were gram positive cocci, 7 isolates (39%) were gram-negative organisms. Two specimens yielded mixed flora (2 bacteria each). The most frequently isolated bacteria were Staphylococcus aureus (5 in 18) and Pseudomonas aureginosa (5 in 18). Conclusion: Culturing vitreous specimens with blood culture bottles may be an alternative to conventional culture media with a high yield positive rate especially in clinics which are unable to have adequate microbiology laboratory facilities. Although gram positive organisms were the most common pathogens in our series, gram negative agents were more frequent than in the literature. We think that breaks in the sterilization chain occurs more frequently in our country and this issue should be adressed more carefully.