Research Article
Volume 11 Issue 1 - 2020
Risk Factors for Pars Plana Vitrectomy for Endogenous Endophthalmitis
Aditya Uppuluri1, Marco A Zarbin1,2 and Neelakshi Bhagat1,2*
1Rutgers New Jersey Medical School, Newark, NJ, USA
2Institute of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, NJ, USA
*Corresponding Author:Neelakshi Bhagat, Institute of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, NJ, USA.
Received: November 20, 2019; Published: December 12, 2019




Abstract

Purpose: The objective is to identify demographic, ocular, and microbial variables that are associated with an increased risk of undergoing pars plana vitrectomy (PPV) as part of management for endogenous endophthalmitis (EE). 

Methods: Using the 2002 - 2013 National Inpatient Survey Database, we performed a cross-sectional observational study of cases of EE. Variables with a p < 0.05 on univariate analysis were included in the multivariate regression model. An adjusted alpha-value of 0.00455 (0.05/11) was calculated using the Bonferroni Correction Method.

Results: A total of 2028 cases of EE were identified. Of these cases, 1821 (89.8%) cases occurred in the adult group (AG) (ages 22+) and 206 (10.2%) cases occurred in the pediatric group (PG) (ages 0 - 21). The average age in the AG was 61.9 years, and the average age in the PG was 2.8 years. Men comprised 54.2% of overall cases (61.2% in PG and 53.5% in AG). Of the 2028 cases of EE, 292 (14.4%) cases underwent vitrectomy: 282 (15.5%) were adult cases and 10 (4.9%) were pediatric cases. Through our univariate analysis, we found that age over 22, cataracts, chorioretinitis, retinal detachment, vitreous hemorrhage, panophthalmitis, orbital inflammation, anterior and posterior synechiae, methicillin-sensitive Staphylococcus aureus (MSSA) infection, and pseudomonal infection were associated with an increased risk of undergoing vitrectomy for EE; conversely, E. coli infection was associated with a decreased risk of undergoing vitrectomy. After multivariate analysis, with Bonferroni Correction to reduce the likelihood of type 1 error, age over 22, retinal detachment, orbital inflammation, synechiae, and MSSA infection remained significant risk factors of undergoing vitrectomy. 

Conclusion: In our analysis, only 10.2% of EE cases occurred in the pediatric group. The proportion of EE cases that underwent vitrectomy was higher in adults (15.5%) than in the pediatric (4.9%) group. Statistically significant variables associated with an increase in the likelihood of undergoing vitrectomy were age > 22 years, retinal detachment, orbital inflammation, anterior and posterior synechiae, and MSSA infection. We also noted that Streptococcal species, MSSA, methicillin resistant Staphylococcus aureus (MRSA), gram negative bacteria, and Candida were the most commonly cultured organisms from the blood of EE patients. 

Keywords: Endophthalmitis; Endogenous Endophthalmitis; Vitrectomy; Risk Factors; PPV; Pars Plana Vitrectomy

References

  1. Durand ML. “Endophthalmitis”. Clinical Microbiology and Infection (2013). 
  2. Kernt M and Kampik A. “Endophthalmitis: Pathogenesis, Clinical Presentation, Management, and Perspectives”. Clinical Ophthalmology (2010).
  3. Lemley CA and Han DP. “Endophthalmitis: A Review of Current Evaluation and Management”. Retina (2007).
  4. Cunningham C., et al. “Endophthalmitis” (2017). 
  5. Egan DJ., et al. Endophthalmitis Clinical Presentation (2018).
  6. Kurniawan ED., et al. “Predictors of Visual Outcome and the Role of Early Vitrectomy in Streptococcal Endophthalmitis”. Clinical and Experimental Ophthalmology (2017).
  7. Davies BW and Fante RG. “Concurrent Endophthalmitis and Orbital Cellulitis From Metastatic Klebsiella Pneumonia Liver Abscess”. Ophthalmic Plastic and Reconstructive Surgery (2016).
  8. Modjtahedi BS., et al. “Intravenous Drug Use–Associated Endophthalmitis”. Ophthalmology Retina (2017).
  9. Patel SN., et al. “Endogenous Endophthalmitis Associated with Intravenous Drug Abuse”. Retina (2014).
  10. Connell PP., et al. “Endogenous Endophthalmitis Associated with Intravenous Drug Abuse”. Retina (2010).
  11. Michelson JB and Friedlaender MH. “Endophthalmitis of Drug Abuse”. International Ophthalmology Clinics (1987).
  12. Maalouf F., et al. “Chronic postoperative endophthalmitis: a review of clinical characteristics, microbiology, treatment strategies, and outcomes”. International Journal of Inflammation (2012). 
  13. El-Sharkawy AM., et al. “The Pathophysiology of Fluid and Electrolyte Balance in the Older Adult Surgical Patient”. Clinical Nutrition (2014).
  14. Grzybowski A., et al. “The Treatment of Postoperative Endophthalmitis: Should We Still Follow the Endophthalmitis Vitrectomy Study More than Two Decades after Its Publication?” Acta Ophthalmologica (2017).
  15. Endophthalmitis Vitrectomy Study. “Results of the Endophthalmitis Vitrectomy Study”. Archives of Ophthalmology (1995). 
  16. Schiedler V., et al. “Culture-Proven Endogenous Endophthalmitis: Clinical Features and Visual Acuity Outcomes”. American Journal of Ophthalmology (2004).
  17. Binder MI., et al. “Endogenous Endophthalmitis”. Medicine (2003).
  18. Zhang YQ and Wen-Ji W. “Treatment Outcomes After Pars Plana Vitrectomy for Endogenous Endophthalmitis”. Retina (2005).
  19. Connell PP., et al. “Endogenous Endophthalmitis: 10-Year Experience at a Tertiary Referral Centre”. Eye (2010).
  20. Yoon YH., et al. “Result of Early Vitrectomy for Endogenous Klebsiella Pneumoniae Endophthalmitis”. Retina (2003).
  21. Jackson TL., et al. “Endogenous Bacterial Endophthalmitis: A 17-Year Prospective Series and Review of 267 Reported Cases”. Survey of Ophthalmology (2003). 
  22. Wong J. “Endogenous Bacterial Endophthalmitis an East Asian Experience and a Reappraisal of a Severe Ocular Affliction”. Ophthalmology (2000).
  23. Kimura D., et al. “A Case of Rhegmatogenous Retinal Detachment at Late Stage Following Endogenous Bacterial Endophthalmitis”. Case Reports in Ophthalmology (2017). 
  24. Nelsen PT., et al. “Retinal Detachment Following Endophthalmitis”. Ophthalmology (1985).
  25. Chiquet C., et al. “Occurrence and Risk Factors for Retinal Detachment after Pars Plana Vitrectomy in Acute Postcataract Bacterial Endophthalmitis”. British Journal of Ophthalmology (2016).
  26. Olson JC., et al. “Results in the Treatment of Postoperative Endophthalmitis”. Ophthalmology (1983).
  27. Foster RE., et al. “Concurrent Endophthalmitis and Retinal Detachment”. Ophthalmology (1994).
  28. Ray S. “Management of Vitreoretinal Complications in Eyes with Permanent Keratoprosthesis”. Archives of Ophthalmology (2002).
  29. Doan A and Carter K. “Pan-Endophthalmitis and Orbital Cellulitis”. Eye (2005).
  30. Lip PL. “A Postoperative Complication Far Worse than Endophthalmitis: the Coexistence of Orbital Cellulitis”. British Journal of Ophthalmology (2001). 
  31. Kassam F., et al. “Concurrent endophthalmitis and orbital cellulitis in a child with congenital glaucoma and a glaucoma drainage device”. Digital Journal of Ophthalmology (2011). 
  32. Luemsamran P., et al. “Orbital Cellulitis and Endophthalmitis in Pseudomonas Septicemia”. Orbit (2008).
  33. Argelich R., et al. “Orbital Cellulitis and Endogenous Endophthalmitis Secondary to Proteus Mirabilis Cholecystitis”. Diagnostic Microbiology and Infectious Disease (2009).
  34. Menon J and Rennie IG. “Endogenous Pseudomonas Endophthalmitis in an Immunocompetent Patient: A Case for Early Diagnosis and Treatment”. Eye (2000): 69.
  35. Luke P and Song A. “Concurrent Endophthalmitis and Orbital Cellulitis: A Review of Clinical Features, Predisposing Factors, And Outcomes”. Investigative Ophthalmology and Visual Science 47.13 (2006): 5283.
  36. Okada AA., et al. “Endogenous Bacterial Endophthalmitis”. Ophthalmology (1994). 
  37. Chung KS., et al. “Clinical Review of Endogenous Endophthalmitis in Korea: A 14-Year Review of Culture Positive Cases of Two Large Hospitals”. Yonsei Medical Journal (2011).
  38. Ness T., et al. “Endogenous Endophthalmitis: Microorganisms, Disposition and Prognosis”. Acta Ophthalmologica Scandinavica (2007). 
  39. Arunachala Murthy T., et al. “ESBL E. Coli Urosepsis Resulting in Endogenous Panophthalmitis Requiring Evisceration of the Eye in a Diabetic Patient”. Case Reports in Infectious Diseases (2015). 
  40. Major JC., et al. “Staphylococcus Aureus Endophthalmitis: Antibiotic Susceptibilities, Methicillin Resistance, and Clinical Outcomes”. American Journal of Ophthalmology (2010).
  41. Ashkan MA., et al. “Staphylococcus aureus Endophthalmitis: Antibiotic Susceptibilities, Methicillin Resistance, and Clinical Outcomes”. Investigative Ophthalmology and Visual Science 53.14 (2012): 1689.
  42. Nishida T., et al. “An Eleven-Year Retrospective Study of Endogenous Bacterial Endophthalmitis”. Journal of Ophthalmology (2015). 
  43. Ho V., et al. “Endogenous Methicillin-Resistant Staphylococcus Aureus Endophthalmitis”. Retina (2011).
  44. Pittner A., et al. “Synechiae”. EyeWiki (2019).
  45. Murugan G., et al. “Clinical Profile and Outcomes of Pediatric Endogenous Endophthalmitis: A Report of 11 Cases from South India”. World Journal of Clinical Pediatrics (2016). 
  46. Haruta M., et al. “Pediatric Endogenous Haemophilus Influenzae Endophthalmitis with Presumed Hyposplenism”. International Medical Case Reports Journal (2017).
  47. Tsai YY and Tseng SH. “Pediatric Endogenous Endophthalmitis”. Journal of the Formosan Medical Association 99.5 (2000): 435-437.
  48. Chaudhry IA., et al. “Pediatric Endogenous Bacterial Endophthalmitis: Case Report and Review of the Literature”. Journal of American Association for Pediatric Ophthalmology and Strabismus (2006). 
  49. Basu S., et al. “Neonatal Endogenous Endophthalmitis: A Report of Six Cases”. Pediatrics (2013). 
Citation: Neelakshi Bhagat., et al. “Risk Factors for Pars Plana Vitrectomy for Endogenous Endophthalmitis”. EC Ophthalmology 11.1 (2020): 01-16

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