Skip to main content

Advertisement

Log in

A case–control study of post-traumatic endophthalmitis at a spanish hospital

  • Original Paper
  • Published:
International Ophthalmology Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Duch-Samper AM, Chaques-Alepuz V, Menezo JL, Hurtado-Sarrio M (1998) Endophthalmitis following open-globe injuries. Curr Opin Ophthalmol 9:59–65

    Article  CAS  PubMed  Google Scholar 

  2. Verbraeken H, Rysselaere M (1994) Post-traumatic endophthalmitis. Eur J Ophthalmol 4:1–5

    CAS  PubMed  Google Scholar 

  3. Bhagat N, Nagori S, Zarbin M (2011) Post-traumatic infectious endophthalmitis. Surv Ophthalmol 56:214–251

    Article  PubMed  Google Scholar 

  4. 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

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. 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

    Article  PubMed  Google Scholar 

  6. 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

    Article  CAS  PubMed  Google Scholar 

  7. 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

    Article  CAS  PubMed  Google Scholar 

  8. Jonas JB, Budde WM (1999) Early versus late removal of retained intraocular foreign bodies. Retina 19:193–197

    Article  CAS  PubMed  Google Scholar 

  9. Duch-Samper AM, Menezo JL, Hurtado-Sarrio M (1997) Endophthalmitis following penetrating eye injuries. Acta Ophthalmol Scand 75:104–106

    Article  CAS  PubMed  Google Scholar 

  10. Woodcock MG, Scott RA, Huntbach J, Kirkby GR (2006) Mass and shape as factors in intraocular foreign body injuries. Ophthalmology 113:2262–2269

    Article  PubMed  Google Scholar 

  11. 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

    Article  CAS  PubMed  Google Scholar 

  12. 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

    Article  PubMed  Google Scholar 

  13. 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

    Article  CAS  PubMed  Google Scholar 

  14. Davey RT Jr, Tauber WB (1987) Posttraumatic endophthalmitis: the emerging role of Bacillus cereus infection. Rev Infect Dis 9:110–123

    Article  PubMed  Google Scholar 

  15. 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

    CAS  Google Scholar 

  16. Alfaro DV, Roth DB, Laughlin RM, Goyal M, Liggett PE (1995) Pediatric post-traumatic endophthalmitis. Br J Ophthalmol 79:888–891

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. 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

    Article  CAS  PubMed  Google Scholar 

  18. Levin, D’Amico DJ (1991) Traumatic endophthalmitis. In: Mosby (ed) Eye trauma. Mosby Year Book, St. Louis, pp 242–252

    Google Scholar 

  19. Affeldt JC, Flynn HW Jr, Forster RK, Mandelbaum S, Clarkson JG, Jarus GD (1987) Microbial endophthalmitis resulting from ocular trauma. Ophthalmology 94:407–413

    Article  CAS  PubMed  Google Scholar 

  20. 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

    Article  PubMed  Google Scholar 

  21. 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

    Article  CAS  PubMed  Google Scholar 

  22. Gupta A, Srinivasan R, Kaliaperumal S, Saha I (2008) Post-traumatic fungal endophthalmitis–a prospective study. Eye (Lond) 22:13–17

    Article  CAS  Google Scholar 

  23. 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

    CAS  PubMed  Google Scholar 

  24. Pflugfelder SC, Flynn HW Jr, Zwickey TA, Forster RK, Tsiligianni A, Culbertson WW, Mandelbaum S (1988) Exogenous fungal endophthalmitis. Ophthalmology 95:19–30

    Article  CAS  PubMed  Google Scholar 

  25. Jonas JB, Knorr HL, Budde WM (2000) Prognostic factors in ocular injuries caused by intraocular or retrobulbar foreign bodies. Ophthalmology 107:823–828

    Article  CAS  PubMed  Google Scholar 

  26. Essex RW, Yi Q, Charles PG, Allen PJ (2004) Post-traumatic endophthalmitis. Ophthalmology 111:2015–2022

    Article  PubMed  Google Scholar 

  27. Kuhn F, Morris R, Witherspoon CD, Heimann K, Jeffers JB, Treister G (1996) A standarized classification of ocular trauma. Ophthalmology 103:240–243

    Article  CAS  PubMed  Google Scholar 

  28. Maldonado G, Greenland S (1993) Simulation study of confounder-selection strategies. Am J Epidemiol 138:923–936

    CAS  PubMed  Google Scholar 

  29. 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

    PubMed  Google Scholar 

  30. Mieler WF, Ellis MK, Williams DF, Han DP (1990) Retained intraocular foreign bodies and endophthalmitis. Ophthalmology 97:1532–1538

    Article  CAS  PubMed  Google Scholar 

  31. 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

    Article  CAS  PubMed  Google Scholar 

  32. Folk JC, Lobes LA Jr (1981) Bacterial endophthalmitis and traumatic hyphema resulting from ocular injuries during dental procedures. Can J Ophthalmol 16:151–152

    CAS  PubMed  Google Scholar 

  33. 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

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. 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

    CAS  PubMed  Google Scholar 

  35. Meredith TA (1999) Posttraumatic endophthalmitis. Arch Ophthalmol 117:520–521

    Article  CAS  PubMed  Google Scholar 

  36. Reynolds DS, Flynn HW Jr (1997) Endophthalmitis after penetrating ocular trauma. Curr Opin Ophthalmol 8:32–38

    Article  CAS  PubMed  Google Scholar 

  37. Peyman GA, Daun M (1994) Prophylaxis of endophthalmitis. Ophthalmic Surg 25:671–674

    CAS  PubMed  Google Scholar 

  38. Seal DV, Kirkness CM (1992) Criteria for intravitreal antibiotics during surgical removal of intraocular foreign bodies. Eye (Lond) 6:465–468

    Article  Google Scholar 

  39. 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

    Article  CAS  PubMed  Google Scholar 

  40. Alfaro DV, Roth D, Liggett PE (1994) Posttraumatic endophthalmitis. Causative organisms, treatment, and prevention. Retina 14:206–211

    Article  CAS  PubMed  Google Scholar 

  41. 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

    CAS  PubMed  Google Scholar 

  42. Negrel AD, Thylefors B (1998) The global impact of eye injuries. Ophthalmic Epidemiol 5:143–169

    Article  CAS  PubMed  Google Scholar 

  43. 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

    Article  PubMed  Google Scholar 

  44. Lipscomb HJ (2000) Effectiveness of interventions to prevent work-related eye injuries. Am J Prev Med 18:27–32

    Article  CAS  PubMed  Google Scholar 

  45. 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

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. Zhang Y, Zhang MN, Jiang CH, Yao Y, Zhang K (2010) Endophthalmitis following open globe injury. Br J Ophthalmol 94:111–114

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

This work was supported by the Foundation for Health Research of Castile—La Mancha [PI-2009/47].

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Maria Angeles Asencio.

Ethics declarations

Conflict of interest

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

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

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10792-015-0099-x

Keywords

Navigation