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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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    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.