In cases of endophthalmitis following cataract surgery, poorer visual outcomes were seen in eyes with positive bacterial cultures and oral flora. Photo: Joseph W. Sowka, OD. Click image to enlarge.

The risk of endophthalmitis has been shown to be low, but research assessing outcomes post-cataract surgery has been limited. In a recent study, researchers aimed to update visual outcomes, microbial spectrum and complications in eyes with endophthalmitis following cataract surgery. They found that endophthalmitis resulted in worse visual outcomes than culture-negative cases, with oral flora-associated cases causing greater visual decline.

A total of 112 cases of endophthalmitis following cataract surgery, including 58 that were culture-positive, were evaluated between 2014 and 2017.

Approximately 70% of eyes achieved vision of 20/200 or better, and half achieved vision of 20/40 or better six months after treatment. Poor visual outcomes were seen in eyes with positive bacterial cultures and oral flora. “Among the culture-positive group, oral flora-associated cases sustained significantly worse vision than non-oral flora-associated cases at the three-month and six-month follow-up,” the authors explained.

Coagulase-negative Staphylococci (CoNS) were the most common isolate, representing over half of the culture-positive cases, which is similar to previous studies. CoNS responded well to intravitreal antibiotics, with one case of vancomycin resistance identified, comparable to previous studies. Additionally, culture-positive endophthalmitis cases had a higher incidence of rhegmatogenous retinal detachment compared with culture-negative cases.

“A higher pathogen burden in culture-positive cases may increase the likelihood of culture growth and worse outcomes,” the authors explained. “Furthermore, as endophthalmitis is a clinical diagnosis, severe sterile intraocular inflammation may be diagnosed as ‘culture-negative’ endophthalmitis.”