[Post-traumatic endophthalmitis after penetrating injury in Vietnam: risk factors, microbiological aspect and visual outcome].

BACKGROUND

Post-traumatic endophthalmitis associated with penetrating injury represents a distinct kind of intraocular infection and is still a severe problem for diagnosis and treatment in developing countries. We report the incidence, microbiological presentation and visual outcome of post-traumatic endophthalmitis in South Vietnam.

PATIENTS AND METHOD: In a retrospective study medical reports of 515 patients with penetrating injury treated at Eye Hospital in Ho Chi Minh city, Vietnam, from 1/1999 to 5/2000 were reviewed and analysed. The treatment was standardised: 1. after vitreous-biopsy intravitreous injection of 0.1 mg/0.1 ml Gentamycine and 1 mg/0.1 ml Vancomycine; 2. subconjunctival injection of 25 mg/0.5 ml Vancomycine and 20 mg/0.5 ml Gentamycine; 3. topical and systemic antibiotic treatment due to microbiological presentation; 4. systemic steroids treatment. Clinical parameters were evaluated for association with an increased risk of endophthalmitis.

RESULTS

Out of 515 patients with penetrating injury 61 patients (11.8 %) with endophthalmitis were treated and evaluated. Mean time interval from trauma to diagnosis of endophthalmitis was 16.8 +/- 5.6 days. Follow-up period was 15.6 +/- 23.4 days. Visual acuity at the diagnosis of endophthalmitis in 96 % of all patients was only finger counting or light perception. Enucleation was needed in 14 % of patients, 29 % of patients developed phthisis bulbi. A visual acuity better than finger counting was reached in only 10 % of all patients with endophthalmitis. Cultures of the vitreous aspirate were positive in only 50 % of cases available and showed Gram-positive (51 %), Gram-negative bacteria (33 %) and fungi (16 %). Risk factors found to be significant were: 1. a purely corneal wound; 2. wound length less than 5 mm; 3. surgical primary repair more than 24 hour after trauma; 4. inadequate antibiotic treatment and 5. a rural injury setting.

CONCLUSION

Post-traumatic endophthalmitis is still a major problem in Vietnam. Delay in primary wound closure or inadequate antibiotic treatment worsen the prognosis profoundly. Comprehensive prophylactic antibiotic treatment at the time of injury repair is in dispensable. In risk eyes particular attention should be paid to prophylaxis and signs of infection. Further prospective studies are necessary to develop optimal and adequate diagnostic and treatment options in Vietnam.