Clinical features, antimicrobial susceptibilities, and treatment outcomes of patients with culture positive endophthalmitis after penetrating keratoplasty

Kimberly D Tran; Nicolas A Yannuzzi; Nancy Si; Nimesh A Patel; Darlene Miller; Guillermo Amescua; Audina M Berrocal; Harry W Flynn Jr

doi:10.1016/j.ajoc.2018.01.011

Clinical features, antimicrobial susceptibilities, and treatment outcomes of patients with culture positive endophthalmitis after penetrating keratoplasty

Am J Ophthalmol Case Rep. 2018 Jan 4:9:62-67. doi: 10.1016/j.ajoc.2018.01.011. eCollection 2018 Mar.

Authors

Kimberly D Tran¹, Nicolas A Yannuzzi¹, Nancy Si¹, Nimesh A Patel¹, Darlene Miller¹, Guillermo Amescua¹, Audina M Berrocal¹, Harry W Flynn Jr¹

Affiliation

¹ Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, FL, USA.

Abstract

Purpose: To report the clinical features organisms and treatment outcomes in patients with endophthalmitis after penetrating keratoplasty (PK).

Methods: Retrospective noncomparative case series.

Results: Eleven eyes of 11 patients with culture positive endophthalmitis after PK were included. The time to diagnosis of endophthalmitis from last PK was less than 1 week in 3/11 (27%), between 1 and 4 weeks in 3/11 (27%), and greater than one month in 5/11 (46%) (range 2-924 days). The distribution of isolates included gram positive (GP) 9/11 (82%), gram negative (GN) 1/11 (9%), and fungal 1/11 (9%) species, respectively. Of GP bacteria tested, 9/9 (100%) were sensitive to Vancomycin. Of fungal isolates tested, none (0/1) were sensitive to Amphoteracin, Fluconazole, and/or Voriconazole. Among patients with rim culture data available, 1/7 (14%) donor rims were culture positive for Candida glabrata and 6/7 (86%) were culture negative. Patients were treated with primary tap and inject in 10/11 (91%) and primary vitrectomy in 1/11 (9%). VA of ≥5/200 was present in 2/11 (18%) at time of endophthalmitis diagnosis, and was recorded in 6/11 (55%) at last follow-up.

Conclusions and importance: Patients with endophthalmitis after PK presented at variable time points after surgery. Gram positive organisms were the most common isolate. VA outcomes after treatment were generally poor.

Keywords: BPEI, Bascom Palmer Eye Institute; CE, cataract extraction; DMEK, Descemet membrane endothelial keratoplasty; DSAEK, descemet stripping automated endothelial keratoplasty; Endophthalmitis; GN, gram negative; GP, Gram positive; HM, Hand motion; IOL, intraocular lens implant; LP, Light perception; NLP, No light perception; PK, penetrating keratoplasty; PPV, vitrectomy; Penetrating keratoplasty; TAP, tap and inject.