Endophthalmitis After Descemet Stripping Endothelial Keratoplasty: Microbiological Yield and Visual Outcomes

• Published in: American journal of ophthalmology 2021-02, Vol.222, p.34-40
• Main Authors: Robbins, Cason B., Feng, Henry L., Wisely, C. Ellis, Daluvoy, Melissa, Fekrat, Sharon
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Bacteria - isolation & purification; Biopsy; Cataracts; Cornea; Descemet Stripping Endothelial Keratoplasty - adverse effects; Endophthalmitis - diagnosis; Endophthalmitis - microbiology; Endothelium; Eye Infections, Bacterial - diagnosis; Eye Infections, Bacterial - microbiology; Eye surgery; Female; Glaucoma; Humans; Male; Middle Aged; Pathogens; Patients; Retrospective Studies; Statistical analysis; Streptococcus infections; Transplants & implants; Visual Acuity; Vitreous Body - microbiology
• ISSN: 0002-9394; 1879-1891
• DOI: 10.1016/j.ajo.2020.08.040

To describe the clinical presentation, management, and visual outcomes of 6 eyes with endophthalmitis after Descemet stripping endothelial keratoplasty (DSEK). Retrospective case series. Setting: Tertiary, academic eye center. StudyPopulation: Individuals developing endophthalmitis after DSEK at the Duke Eye Center from January 1, 2009, to January 1, 2018, with at least 6 months of follow-up. ObservationProcedure: Retrospective chart review. OutcomeMeasures: Diagnostic procedures, microbiological yield, and visual outcomes. Six eyes of 6 patients were identified. Mean time from surgery to presentation was 51 days (range, 4-137 days). Dense vitreous opacities were present in all cases. Five of 6 cases (83%) had culture-proven infectious endophthalmitis (2 Candida glabrata, 2 coagulase-negative Staphylococcus, 1 Streptococcus pneumoniae). Aqueous tap yielded positive culture in 2 of 2 cases with adequate sample (100%); needle vitreous tap yielded positive culture in 0 of 3 cases. One eye underwent vitrectomy on presentation, and 3 eyes (50%) underwent subsequent vitrectomy for persistent endophthalmitis after a mean of 37 days. Mean pre-endophthalmitis visual acuity (VA) was 20/64; mean VA at 6 months was 20/2069 (average 15 ETDRS lines lost). VA at 6 months was light perception or no light perception in 3 of 6 cases (50%). One eye underwent enucleation at 6 months, and 1 eye became phthisical 1 year after endophthalmitis. DSEK-related endophthalmitis may lead to severe vision loss, even with prompt and appropriate treatment. Aqueous tap had a higher culture yield than needle vitreous tap in our series.