Clinical Study Of Infectious Endophthalmitis After Cataract Surgery

Objective: To study the clinical features,treatment methods,visual prognosis,distribution of pathogens and drug sensitivity of pathogenic bacteria of infectious endophthalmitis after cataract surgery.Methods: The medical records of patients with infective endophthalmitis after cataract surgery from Yantai Yuhuangding Hospital from 2007 to 2018 were collected.The time,clinical features,treatment methods,visual prognosis,distribution of pathogens and drug sensitivity of pathogens were summarized.The differences in visual acuity distribution before and after treatment were compared by chi-square test.The significant differences related to visual prognosis were tested by Pearson chi-square test,Fisher exact probability and chi-square continuity correction formula.The correlation analysis of visual prognosis was performed by Spearman rank correlation.Results: A total of 43 patients with ocular infection after endophthalmitis were treated in Yantai Yuhuangding Hospital,including 40 cases of acute infectious endophthalmitis(40/43,93%)and chronic infectious endophthalmitis(3 /43,7%).The average time of onset of acute infectious endophthalmitis was within 2 weeks after cataract surgery.The population was over 70 years old(18/43,41.9%)and women were multiple(27/43,62.8%).There were 2 cases of ECCE(1/43,2.3%)in cataract surgery,1 case of phacoemulsification combined with intraocular lens suspension(1/43,2.3%),and 40 cases of phacoemulsification combined with intraocular lens implantation(40/ 43,93%).Among the causes of the disease,there were 3 cases of posterior capsule rupture during cataract surgery,1 case of anterior chamber puncture after cataract surgery,and 1 cases of cataract surgery without eye surgery.Acute infectious endophthalmitis,the average time interval from cataract to infection symptoms was 12.15±10.33 days,and the average time interval from infection to visit was 4.36±6.43 days.Chronic infectious endophthalmitis,the average time interval from cataract to infection symptoms was 4.67±3.05 months,and the average time interval from infection to visit was 3.34±3.03 months.Most of the clinical symptoms of acute infectious endophthalmitis are accompanied by decreased vision,red eyes,and eye pain.Most of the eye signs are accompanied by corneal edema,anterior chamber empyema,vitreous cavity infection,and invisible eyes.Most of the clinical symptoms of chronic infective endophthalmitis after cataract are accompanied by redness,eye pain,photophobia,and tearing.In the eye signs,there are decreased vision,vitreous cavity infection,and invisible eyes.All patients in this group were treated with local and systemic antibiotics,including 3 eyes(3/43,7.0%)with local and systemic antibiotics and 11 eyes with intravitreal injections(11/43,25.6%),anterior chamber irrigation combined with vitreous cavity injection in 3 eyes(3/43,7.0%).A total of 26eyes(26/43,60.5%)underwent vitrectomy,including anterior chamber irrigation combined with vitreous cavity injection combined with vitrectomy for 7 eyes(7/43,16.3%),vitreous cavity injection combined with vitrectomy combined with silicone oil Filling 13 eyes(13/43,30.2%),vitreous cavity injection combined with vitrectomy combined with intraocular lens to remove 4 eyes(4/43,9.3%),vitreous cavity injection combined with vitrectomy combined with silicone oil filling combined with intraocular lens removal 2 eyes(2/43,4.7%),no eyeballs.Among the 43 patients,the number of positive cases in vitreous cavity culture was 21,the positive rate of culture was 48.8%,Gram-positive bacteria accounted for 85.7%,of which Staphylococcus epidermidis accounted for 33.3%,followed by Enterococcus faecalis accounted for 28.6%,Staphylococcus aureus Accounted for 14.3%.There were 2 cases of Gram-negative bacteria,accounting for 9.5%,which were respectively S.maltophilia and Xylose oxidizing Alcaligenes.One case of filamentous fungi accounted for 4.8%.Among the 18Gram-positive bacteria,the antibiotics with 100% sensitivity to pathogens were vancomycin,tigecycline and rifampicin.The sensitivity of moxifloxacin was 85.7%,and the sensitivity of penicillin was 41.2%.The decrease in ciprofloxacin(37.5%),gentamicin(35.3%),ofloxacin(33.3%)and tetracycline(30.8%).The drug sensitivity of Staphylococcus epidermidis in Gram-positive bacteria is higher in vancomycin(100%),tigecycline(100%),rifampicin(100%),moxifloxacin(85.7%),and Damycin(71.4%),ciprofloxacin(16.7%),penicillin(14.3%)and ofloxacin(0%)were less sensitive.Gram-negative bacteria are 100% sensitive to ofloxacin,and ciprofloxacin and gentamicin are 0% sensitive.Before treatment,the visual acuity of most patients was light or manual.The total visual acuity increased after treatment.The visual acuity of patients was 0.1~0.4 at one week after treatment and at the end of follow-up.The chi-square test was performed on the distribution of visual acuity before and after treatment.The differences between the three groups were statistically significant(p = 0.000,<0.05).Before surgery,62.8% of the patients had light perception or manual operation.27.9% of the patients had a visual acuity of 0.02-0.1,and 39.5% of the patients had a visual acuity of 0.1-0.4.At the end of follow-up,34.9% of the patients had a visual acuity of 0.1 to 0.4,and 20.9% of the patients had a visual acuity of ?0.5,and 20.9% of the patients had no visual acuity.Baseline visual acuity(P=0.01,<0.05),anterior chamber empyema(p=0.033,<0.05),corneal condition(P=0.001,<0.05),vitreous cavity pathogen culture(P=0.012,<0.05)and presence or absence diabetes(p=0.025,<0.05)were significant difference in visual prognosis between the two groups.The difference was statistically significant,but gender(P=0.384,<0.05)had no significant difference with visual prognosis.There was a significant negative correlation between the time interval from cataract to the onset of infection symptoms and visual prognosis (P=0.000,<0.05,r=-0.455).There was a significant negative correlation between the time of infection and the time interval between the visit and the visual prognosis(P=0.000<0.05,r =-0.680).Conclusion: Infective endophthalmitis after cataract surgery mostly occurs within 2 weeks after cataract surgery.Most of the eye symptoms are accompanied by decreased vision,red eyes and eye pain.Most of the eye signs are accompanied by corneal edema,anterior chamber empyema and vitreous cavity.Infection and fundus are not visible.More than half of patients require vitrectomy.Staphylococcus epidermidis is the most common pathogen.Among Gram-positive bacteria,vancomycin,tigecycline and rifampicin have the highest sensitivity,and Gram-negative bacteria are most sensitive to ofloxacin.Baseline visual acuity,anterior chamber empyema,corneal edema or not,vitreous cavity pathogen culture and whether or not diabetes affects visual prognosis,the time interval from cataract to infection symptoms and the longer the interval between infection and treatment,the worse the visual prognosis early treatment and standardized treatment can achieve better visual prognosis.