Baseline factors predictive of visual prognosis in acute postoperative bacterial endophthalmitis in patients undergoing cataract surgery.

IMPORTANCE

Although rare, postoperative endophthalmitis in patients undergoing cataract surgery can lead to anatomical or functional loss of the eye. Therapeutic strategies such as antibiotic prophylaxis and microbiological diagnosis are more effective with a target patient population. New prospective data are needed to identify prognostic factors.

OBJECTIVE

To identify baseline factors of visual prognosis in patients with acute bacterial endophthalmitis after cataract surgery.

DESIGN

Prospective study of consecutive patients undergoing cataract surgery, enrolled from March 1, 2004, through December 31, 2005. We analyzed outcomes to determine the effect on the final visual outcome, defined as poor (visual acuity [VA] worse than 20/100) or good (VA 20/40 or better) using univariate and multivariate analysis.

SETTING

Four academic hospitals.

PARTICIPANTS

Ninety-nine consecutive patients with cataract.

INTERVENTION: Corneal phacoemulsification.

MAIN OUTCOMES AND MEASURES: Factors related to the cataract surgery (complications), initial clinical presentation, and microbiological diagnosis and the final VA.

RESULTS

The significant baseline factors (at presentation) for good visual outcome (45% of the series) were the winter season, absence of complications during cataract surgery, initial VA, microbiological investigations revealing no microorganism or a coagulase-negative Staphylococcus species (CNSP), and fundus visibility. Quantitative factors associated with a good clinical prognosis were shorter duration of cataract surgery, younger age, and a hypopyon no greater than 1.5 mm. Significant factors associated with poor visual outcome were infection of the right eye, initial VA, corneal edema, a hypopyon larger than 1.5 mm, detection of bacterial species other than a CNSP, and the absence of fundus visibility. Multiple logistic regression analysis showed that high bacterial virulence was the only independent factor (odds ratio, 14.0 [95% CI, 2.7-71.0]; P = .001) for poor visual outcome. On the other hand, low bacterial virulence (odds ratio, 0.2 [95% CI, 0.03-0.6]; P = .01) and the absence of complications during cataract surgery (0.1 [0.01-0.4]; P = .003) were independent factors for good VA.

CONCLUSIONS AND RELEVANCE: Most clinical outcome factors in acute postoperative endophthalmitis can be identified at presentation. The bacterial virulence level is the main factor predictive of the final visual prognosis.