Bacterial endophthalmitis following extracapsular cataract extraction: recommendations for early detection.

OBJECTIVE

To determine the time between the onset of symptoms of endophthalmitis after cataract extraction and presentation to an ophthalmologist and to determine the spectrum of organisms responsible for postoperative endophthalmitis.

DESIGN

Case series.

SETTING

Tertiary care vitreoretinal service in Toronto.

PATIENTS: Thirty-three patients with early (presentation within 2 weeks of surgery) endophthalmitis following extracapsular cataract extraction and intraocular lens implantation performed between January 1989 and December 1992.

OUTCOME MEASURES: Time to presentation to an ophthalmologist, duration of symptoms, culture results.

RESULTS

Twenty-two patients (66.7%) were documented to experience identifiable symptoms of endophthalmitis before presentation to their ophthalmologist; the mean time of onset of symptoms was 3.6 (standard deviation [SD] 1.7) days after surgery. Of the 22 patients 16 (72.7%) became symptomatic by the fourth postoperative day, and 21 (95.4%) experienced symptoms by the fifth postoperative day. The mean delay between onset of symptoms and presentation was 1.9 (SD 1.6) days. Bacteria were identified in 27 cases (81.8%), confirmed by culture in 23 cases (69.7%). The organisms were gram-positive in 25 (92.6%) of the 27 cases, and coagulase-negative Staphylococcus predominated.

CONCLUSIONS

In our series a considerable delay existed between the development of symptoms of endophthalmitis following extracapsular cataract extraction and clinical diagnosis. This delay could be minimized by scheduling routine postoperative visits at 1 and 4 days following cataract surgery.