Cafer TANRIVERDİ, Firdevs ÖRNEK, Ümit EKŞİOĞLU, Mehmet Akif ACAR, Ayşe BURCU

POSTOPERATİF ENDOFTALMİLİ OLGULARIN TEDAVİSİ VE KLİNİK SONUÇLAR

AMAÇ: Postoperatif endoftalmi göz cerrahisinde en çok korkulankomplikasyonların başında gelmektedir. Bu çalışmada postoperatifendoftalmi görülme sıklığı, klinik özellikler, risk faktörleri, tedaviyaklaşımları ve prognoz araştırılmıştır.GEREÇ VE YÖNTEM: Çalışmaya Ankara Eğitim ve AraştırmaHastanesi Göz Kliniği'nde postoperatif endoftalmi tanısı alanolgular dahil edildi. Postoperatif endoftalmi görülme sıklığı,hastaların oküler ve sistemik hastalıkları, başvuru semptomları, gözmuayene bulguları, bakteriyel kültür sonuçları, uygulanan medikalve cerrahi tedaviler ve prognoz incelendi.BULGULAR: Çalışmaya postoperatif endoftalmi tanısı alan 41 olgudahil edildi. Olguların yaş ortalaması 62.8 ± 22.4 yıl idi. Endoftalmi38 gözde (%92.8) katarakt cerrahisi ve/veya göz içi mercekimplantasyonu sonrasında, 1 gözde (%2.4) trabekülektomi, 1 gözde(%2.4) penetran keratoplasti ve 1 gözde (%2.4) pars plana vitrektomisonrası gelişmişti. Olgularda ameliyat sonrasında hastaneye başvurusüresi ortalama 15.7 ± 17.5 (2-60) gündü. Vitreus / hümör aközkültürü olguların %46.3’ünde pozitifti. Tüm olgulara en az bir kezintravitreal antibiyotik enjeksiyonu ve 15 (%36.6) olguya pars planavitrektomi yapıldı. Işık hissini kaybeden 7 olgudan 3’üne evisserasyonuygulandı. Olgular ortalama 11.1 ± 4.9 (6-25) ay takip edildi. Takipsonucunda 7 (%17.1) olguda ışık hissi kaybı görülürken, 12 (%29.3)olgu ışık hissi-el hareketi, 11 (%26.8) olgu 1 metreden parmak sayma-

TREATMENT AND CLINICAL RESULTS IN CASES WITH POSTOPERATIVE ENDOPHTHALMITIS

INTRODUCTION: Postoperative endophthalmitis is one of the most frustrating complications of ophthalmic surgery. In this study we aimed to evaluate the postoperative endophthamitis incidence, clinical features, risk factors, treatment strategies and prognosis in patients with postoperative endophthalmitis. MATERIAL AND METHOD: We evaluated postoperative endophthalmitis cases in Ankara Training and Research Hospital, Department of Ophthalmology. Postoperative endophthamitis incidence, ocular and systemic illness, initial symptoms, eye examination findings, bacteriologic culture results, medical and surgical treatments and prognosis were investigated. RESULTS: Forty-one patients with postoperative endophthalmitis were included in the study. The mean age was 62.8 ± 22.4 years (range 2 months - 90 years). Endophthalmitis developed in 38 eyes (92.8%) after cataract surgery and/or intraocular lens implantation, in 1 eye (2.4%) after glaucoma surgery, in 1 eye (2.4%) after penetrating keratoplasty and in 1 eye (2.4%) after pars plana vitrectomy. The mean duration of admission to the hospital postoperatively was 15.7 ± 17.5 (2-60) days. Cultures from vitreous / aqueous humor specimens were positive in %46.3 of the patients. All the cases had at least one intravitreal antibiotic injection. Pars plana vitrectomy was performed in 15 cases (36.6%). Evisceration was performed to 3 of 7 patients who lost their sense of light. The mean follow-up was 11.1 ± 4.9 (6-25) months. Light perception was lost in 7 cases (17.1%). Visual acuity was between light perception-hand motion in 12 cases (29.3%), counting finger from a meter –

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1.)Hatch WV, Cernat G, Wong D, Devenyi R, Bell CM. Risk factors for acute endophthalmitis after cataract surgery: a populationbased study. Ophthalmology. 2009; 116(3): 425-430. doi:10.1016/j. ophtha.2008.09.039.
2.)West ES, Behrens A, McDonnell PJ, Tielsch JM, Schein OD. The incidence of endophthalmitis after cataract surgery among the U.S. Medi¬care population increased between 1994 and 2001. Ophthalmology. 2005; 112(8): 1388-1394. doi:10.1016/j. ophtha.2005.02.028.
3.)Lundström M, Wejde G, Stenevi U, Thorburn W, Montan P. Endophthalmitis after cataract surgery: a nation wide prospective study evalu¬ating incidence in relation to incision type and location. Oph¬thalmology. 2007; 114(5): 866-870. doi :10.1016/j. ophtha.2006.11.025
4.)Kattan HM, Flynn HW Jr, Pflugfelder SC, Robertson C, Forster RK. Nosocomial endophthalmitis survey. Current incidence of infection after intraocular surgery. Ophthalmology. 1991; 98(2): 227-238.
5.)Mollan SP, Gao A, Lockwood A, Durrani OM, Butler L. Postcataract endophthalmitis: incidence and microbial isolates in a United Kingdom region from 1996 through 2004. J Cataract Refract Surg. 2007;33(2):265-268. doi :10.1016/j.jcrs.2006.10.022
6.)Barry P, Seal DV, Gettinby G, Lees F, Peterson M, Revie CW; ESCRS Endophthalmitis Study Group. ESCRS study of prophylaxis of postoperative endophthalmitis after cataract surgery: Preliminary report of principal results from a European multicenter study. J Cataract Refract Surg. 2006; 32(3): 407-410. doi: 10.1016/j.jcrs.2006.02.021.
7.)Garat M, Moser CL, Martín-Baranera M, Alonso-Tarrés C, Alvarez-Rubio L. Prophylactic intracameral cefazolin after cataract surgery: endophthalmitis risk reduction and safety results in a 6-year study. J Cataract Refract Surg. 2009; 35(4): 637-642. doi:10.1016/j. jcrs.2008.12.023.
8.)Lane SS, Osher RH, Masket S, Belani S. Evaluation of the safety of prophylactic intracameral moxifloxacin in cataract surgery. J Cataract Refract Surg. 2008; 34(9): 1451-1459. doi:10.1016/j. jcrs.2008.05.034.
9.)Rahmani S, Eliott D. Postoperative Endophthalmitis: A Review of Risk Factors, Prophylaxis, Incidence, Microbiology, Treatment, and Outcomes. Semin Ophthalmol. 2018; 33(1): 95-101. doi:10.10 80/08820538.2017.1353826.
10.)Yalçındağ FN, Özdemir Ö, Bayram N. Endoftalmi ve tedavisinde gelişmeler. MN Oftalmoloji, 2007;14 (3); 226-230.
11.)Endophthalmitis Vitrectomy Study Group. Results of the Endophthalmitis Vitrectomy Study: A randomized trial of immediate vitrectomy and of intravenous antibiotics for the treatment of postoperative bacterial endophthalmitis. Arch Ophthalmol. 1995; 113(12): 1479-1496.
12.)Ocak SY, Altan T, Ocak OB, Kapran Z. Postoperatif Endoftalmilerde girişimsel tedavi yaklaşımı sonuçları. İstanbul Med J. 2013; 14: 8-11. doi: 10.5152/imj.2013.02.
13.)Altan T, Acar N, Kapran Z, Unver YB, Yurttaser S, Küçüksümer Y, Eser I. Acute-onset endophthalmitis after cataract surgery: success of initial therapy, visual outcomes, and related factors. Retina 2009; 29(5): 606-612. doi: 10.1097/IAE.0b013e3181953a31.
14.)Kuhn F, Gini G. Ten years after….are findings of the endo¬phthalmitis vitretomy study stil relevant today? Graefes Arch Clin Exp Ophthalmol. 2005;243(12):1197-1199. doi:10.1007/ s00417-005-0082-8
15.)Siqueira RC, Gil AD, Canamary F, Minari M, Jorge R. Pars plana vitrectomy and silicone oil tamponade for acute endophthalmitis treatment. Arq Bras Oftalmol. 2009; 72(1): 28-32.
16.)American Academy of Ophthalmology, Basic and Clinical Science Course, San Francisco-CA, USA; 1999- 2000. Intraocular inflammation and uveitis, Section 9,197-210.
17.)Mino de Kaspar H, Koss MJ, He L, Blumenkranz MS, Ta CN. Antibiotic susceptibility of preoperative normal conjunctival bacteria. Am J Ophtalmol. 2005; 139(4): 730-733. doi:10.1016/j. ajo.2004.10.007
18.)Akbatur HH, Şengün A. Behçet Hastalığı, Endoftalmiler ve Üveitler, Bölüm 31, İstanbul, Atlas Kitapçılık 2002;415-61.
19.)Bilen H, Tuğcu B, Helvacıoğlu F, Ağaçhan A, Erşahin C, Şencan S. Endoftalmi ve pro-filaksisi. Bakırköy Tıp Dergisi. 2007;3:85-88.
20.)Öztürk M, Hacıbekiroğlu A, Hoca S, Çivaş S. Postoperatif end¬oftalmide pars plana vitrektomi. Ret-Vit. 2002; 10(3): 273-277.
21.)Özdek Ş, Sarı A, Altınsoy A, Gürelik G, Hasanreisoğlu B. Eksojen endoftalmide te¬davi yaklaşımı ve sonuçlarımız. Ret-Vit. 2002; 10(2): 177-183.
22.)Kaynak S, Durak İ, Bahar İH, Kazancı L. Endoftalmide pars pla¬na vitrektomi. Ret-Vit. 1993; 1(2): 179-188.
23.)Benz MS, Scott IU, Flynn HW Jr, Unonius N, Miller D. Endophthalmitis isolates and antibiotic sensitivities: a 6-year review of culture-proven cases. Am J Ophthalmol. 2004; 137(1): 38-42.
24.)Wong TY, Chee SP. The epidemiology of acute endophthalmitis after cataract surgery in an Asian population. Ophthalmology. 2004; 111(4): 699-705. doi: 10.1016/j.ophtha.2003.07.014
25.)Arıkan Ö, Demir N, Alp MN, Yarangümeli A, Kural G. Katarakt ameliyatı sonrası ağır görme kaybı ile başvuran akut endoftalmilerde görme prognozu. Ret-Vit. 2006; 14(1): 37-40.