Abstract
Our aim was to identify the potential risk factors for developing post-traumatic endophthalmitis (PTE) and the possible measures of prevention. Retrospective case–control study, with 15 cases of PTE and 2 matched controls. We reviewed the medical records of the cases and their respective controls during the period 1996–2008 at a Spanish Hospital. We collected demographic data and information about the type of trauma, the potential risk factors, comorbidities, microbial isolations, antimicrobial susceptibility, administered treatments, and the visual outcome. The independent predictor factors identified for PTE were intraocular foreign body (IOFB) (OR 5.48; CI 95 % 1.05–28.7), dirty wound (OR 4.91; CI 95 % 0.96–25.3), and wound closure delays of 24 h or more (OR 5.48; CI 95 % 1.05–28.7). The probability of endophthalmitis in patients without these risk factors was 5.9 %, but ascended to 65.3 % and 90.3 %, in those patients with two and three risk factors, respectively. Infected patients presented a complication rate of 80 %, with an evisceration rate of 53 %; both were significantly associated with infection. The visual outcome was poor and related to the presence of IOFB and virulent microorganisms (Bacillus sp., filamentous fungus), visual acuity at presentation, and retinal detachment. Patients who presented an IOFB, dirty wound, and delayed wound closure were 15 times more likely to develop infection, and when infected, patients fared much worse than those non-infected. We thus recommend aggressive prophylactic measures in patients with these risk factors, adding antifungal prophylaxis when the injury is contaminated with vegetable matter.
Similar content being viewed by others
References
Duch-Samper AM, Chaques-Alepuz V, Menezo JL, Hurtado-Sarrio M (1998) Endophthalmitis following open-globe injuries. Curr Opin Ophthalmol 9:59–65
Verbraeken H, Rysselaere M (1994) Post-traumatic endophthalmitis. Eur J Ophthalmol 4:1–5
Bhagat N, Nagori S, Zarbin M (2011) Post-traumatic infectious endophthalmitis. Surv Ophthalmol 56:214–251
Nobe JR, Gomez DS, Liggett P, Smith RE, Robin JB (1987) Post-traumatic and postoperative endophthalmitis: a comparison of visual outcomes. Br J Ophthalmol 71:614–617
Sabaci G, Bayer A, Mutlu FM, Karagul S, Yildirim E (2002) Endophthalmitis after deadly-weapon-related open-globe injuries: risk factors, value of prophylactic antibiotics, and visual outcomes. Am J Ophthalmol 133:62–69
Thompson JT, Parver LM, Enger CL, Mieler WF, Liggett PE (1993) Infectious endophthalmitis after penetrating injuries with retained intraocular foreign bodies. National Eye Trauma System. Ophthalmology 100:1468–1474
Thompson WS, Rubsamen PE, Flynn HW Jr, Schiffman J, Cousins SW (1995) Endophthalmitis after penetrating trauma. Risk factors and visual acuity outcomes. Ophthalmology 102:1696–1701
Jonas JB, Budde WM (1999) Early versus late removal of retained intraocular foreign bodies. Retina 19:193–197
Duch-Samper AM, Menezo JL, Hurtado-Sarrio M (1997) Endophthalmitis following penetrating eye injuries. Acta Ophthalmol Scand 75:104–106
Woodcock MG, Scott RA, Huntbach J, Kirkby GR (2006) Mass and shape as factors in intraocular foreign body injuries. Ophthalmology 113:2262–2269
Ormerod LD, Becker LE, Cruise RJ, Grohar HI, Paton BG, Frederick AR Jr, Topping TM, Weiter JJ, Buzney SM, Baker AS (1993) Endophthalmitis caused by the coagulase-negative staphylococci. 2. Factors influencing presentation after cataract surgery. Ophthalmology 100:724–729
Chhabra S, Kunimoto DY, Kazi L, Regillo CD, Ho AC, Belmont J, Maguire J, Vander J, Brown GC (2006) Endophthalmitis after open globe injury: microbiologic spectrum and susceptibilities of isolates. Am J Ophthalmol 142:852–854
Soheilian M, Rafati N, Mohebbi MR, Yazdani S, Habibabadi HF, Feghhi M, Shahriary HA, Eslamipour J, Piri N, Peyman GA (2007) Prophylaxis of acute post-traumatic bacterial endophthalmitis: a multicenter, randomized clinical trial of intraocular antibiotic injection, report 2. Arch Ophthalmol 125:460–465
Davey RT Jr, Tauber WB (1987) Posttraumatic endophthalmitis: the emerging role of Bacillus cereus infection. Rev Infect Dis 9:110–123
Abuel-Asrar AM, al-Amro SA, al-Mosallam AA, al-Obeidan S (1999) Posttraumatic endophthalmitis: causative organisms and visual outcome. Eur J Ophthalmol 9:21–31
Alfaro DV, Roth DB, Laughlin RM, Goyal M, Liggett PE (1995) Pediatric post-traumatic endophthalmitis. Br J Ophthalmol 79:888–891
Kunimoto DY, Das T, Sharma S, Jalali S, Majji AB, Gopinathan U, Athmanathan S, Rao TN (1999) Microbiologic spectrum and susceptibility of isolates: part II. Posttraumatic endophthalmitis. Endophthalmitis Research Group. Am J Ophthalmol 128:242–244
Levin, D’Amico DJ (1991) Traumatic endophthalmitis. In: Mosby (ed) Eye trauma. Mosby Year Book, St. Louis, pp 242–252
Affeldt JC, Flynn HW Jr, Forster RK, Mandelbaum S, Clarkson JG, Jarus GD (1987) Microbial endophthalmitis resulting from ocular trauma. Ophthalmology 94:407–413
Tena D, Carranza R, Celis J, Núñez-Sánchez A (2004) Dolor ocular postraumático y ceguera diferida en un paciente del medio rural. Enferm Infecc Microbiol Clin 22:432–433
Pintor E, Martín M, García P, González M (2001) Endoftalmitis por Paecilomyces lilacinus después de un traumatismo penetrante no quirúrgico. Enferm Infecc Microbiol Clin 19:347–348
Gupta A, Srinivasan R, Kaliaperumal S, Saha I (2008) Post-traumatic fungal endophthalmitis–a prospective study. Eye (Lond) 22:13–17
Carranza R, López N, González F, Domínguez J, Amigo A, Martínez F (1998) Perforación ocular en medio agrario. Enferm Infecc Microbiol Clin 16:377–378
Pflugfelder SC, Flynn HW Jr, Zwickey TA, Forster RK, Tsiligianni A, Culbertson WW, Mandelbaum S (1988) Exogenous fungal endophthalmitis. Ophthalmology 95:19–30
Jonas JB, Knorr HL, Budde WM (2000) Prognostic factors in ocular injuries caused by intraocular or retrobulbar foreign bodies. Ophthalmology 107:823–828
Essex RW, Yi Q, Charles PG, Allen PJ (2004) Post-traumatic endophthalmitis. Ophthalmology 111:2015–2022
Kuhn F, Morris R, Witherspoon CD, Heimann K, Jeffers JB, Treister G (1996) A standarized classification of ocular trauma. Ophthalmology 103:240–243
Maldonado G, Greenland S (1993) Simulation study of confounder-selection strategies. Am J Epidemiol 138:923–936
Larque-Daza AB, Peralta-Calvo J, Lopez-Andrade J (2010) Epidemiology of open-globe trauma in the southeast of Spain. Eur J Ophthalmol 20:578–583
Mieler WF, Ellis MK, Williams DF, Han DP (1990) Retained intraocular foreign bodies and endophthalmitis. Ophthalmology 97:1532–1538
Feist RM, Lim JI, Joondeph BC, Pflugfelder SC, Mieler WF, Ticho BH, Resnick K (1991) Penetrating ocular injury from contaminated eating utensils. Arch Ophthalmol 109:63–66
Folk JC, Lobes LA Jr (1981) Bacterial endophthalmitis and traumatic hyphema resulting from ocular injuries during dental procedures. Can J Ophthalmol 16:151–152
Steele C, Lucas DR, Ridgway AE (1984) Endophthalmitis due to caterpillar setae: surgical removal and electron microscopic appearances of the setae. Br J Ophthalmol 68:284–288
Doi M, Ikeda T, Yasuhara T, Koizumi K, Nakamura T (1999) A case of bacterial endophthalmitis following perforating injury caused by a cat claw. Ophthalmic Surg Lasers 30:315–316
Meredith TA (1999) Posttraumatic endophthalmitis. Arch Ophthalmol 117:520–521
Reynolds DS, Flynn HW Jr (1997) Endophthalmitis after penetrating ocular trauma. Curr Opin Ophthalmol 8:32–38
Peyman GA, Daun M (1994) Prophylaxis of endophthalmitis. Ophthalmic Surg 25:671–674
Seal DV, Kirkness CM (1992) Criteria for intravitreal antibiotics during surgical removal of intraocular foreign bodies. Eye (Lond) 6:465–468
Williams DF, Mieler WF, Abrams GW, Lewis H (1988) Results and prognostic factors in penetrating ocular injuries with retained intraocular foreign bodies. Ophthalmology 95:911–916
Alfaro DV, Roth D, Liggett PE (1994) Posttraumatic endophthalmitis. Causative organisms, treatment, and prevention. Retina 14:206–211
Rubsamen PE, Cousins SW, Martinez JA (1997) Impact of cultures on management decisions following surgical repair of penetrating ocular trauma. Ophthalmic Surg Lasers 28:43–49
Negrel AD, Thylefors B (1998) The global impact of eye injuries. Ophthalmic Epidemiol 5:143–169
Sprince NL, Zwerling C, Whitten PS, Lynch CF, Burmeister LF, Gillette PP, Thu K, Alavanja MC (2008) Farm activities associated with eye injuries in the Agricultural Health Study. J Agromedicine 13:17–22
Lipscomb HJ (2000) Effectiveness of interventions to prevent work-related eye injuries. Am J Prev Med 18:27–32
Mancini G, Baldasseroni A, Laffi G, Curti S, Mattioli S, Violante FS (2005) Prevention of work related eye injuries: long term assessment of the effectiveness of a multicomponent intervention among metal workers. Occup Environ Med 62:830–835
Zhang Y, Zhang MN, Jiang CH, Yao Y, Zhang K (2010) Endophthalmitis following open globe injury. Br J Ophthalmol 94:111–114
Acknowledgments
This work was supported by the Foundation for Health Research of Castile—La Mancha [PI-2009/47].
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare no conflict of interest.
Rights and permissions
About this article
Cite this article
Asencio, M.A., Huertas, M., Carranza, R. et al. A case–control study of post-traumatic endophthalmitis at a spanish hospital. Int Ophthalmol 36, 185–194 (2016). https://doi.org/10.1007/s10792-015-0099-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10792-015-0099-x