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Cataract surgery clinical features, treatment and operational difficulties in management of cluster endophthalmitis

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Original Article

Author Details : Rishabh Rathi, Rimpi Rana, Nitin Nema, Rajendra P Maurya*, Neeraj Gaur, Amisha Jain, Siddharth Patel, Abha Verma, Vaibhavi Subedar

Volume : 10, Issue : 1, Year : 2024

Article Page : 37-44

https://doi.org/10.18231/j.ijceo.2024.006

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Abstract

Background: Cataract surgery is the most common ophthalmic surgery performed. Postoperative endophthalmitis is a rare but devastating situation for both patient and doctor. Cluster endophthalmitis is defined as five or more cases of endophthalmitis occurring on a particular day in a single operating room at one centre. Early diagnosis and appropriate management can salvage the affected eye. There are various factors that determine the prognosis in endophthalmitis. Polymicrobial etiology, family support, accessibility to health services, time-lapsed between onset of symptoms and initiation of treatment play an important role in final visual outcome.
Purpose: To evaluate clinical features, management and final outcome in 64 cases of cluster endophthalmitis, and to identify the operational difficulties in managing cluster endophthalmitis in eye camp setting.
Materials and Methods: This is a retrospective study done in 64 out of 94 patients, operated for cataract surgery in an eye camp setting, who presented with features of endophthalmitis. The demographic details, clinical features at presentation and management were evaluated from medical records. Assessment of problems faced by the patients during this period was done on the basis of detailed history given by the patient. Further, the reason for these operational difficulties were discussed with camp organizers.
Results: Out of 64 patients there were 31(48.4%) males and 33(51.6%) female. Mean age of patients was 60 ± 15.3 years. The patients presented between postoperative day 7to 30. Visual acuity of all 64(100%) patients was poor where 59(92.2%) cases ranged between hand movement to perception of light while 5(7.8%) denied perception of light. The cultures were positive in 43(67.18%) cases out of 64 patients. The cultures reported with polymicrobial etiology with fungal growth in 31(48.43%) patients while 12(18.75%) cases showed bacterial growth. Management was done on the basis of Endophthalmitis vitrectomy study (EVS) guidelines. Only 6(9.37%) cases showed improvement in vision from baseline although all 64(100%) cases showed clinical and symptomatic improvement at the time of discharge. There was delay in presentation as no patient reported in 1 postoperative week. 31(48.4%) patients reported in 2 post-operative week causing delay due to attitudinal problems. 19(29.6%) cases reported in 3 week which was due delay in transportation and 14(21.8%) cases reported in 4 week due to illiteracy and neglect.
Conclusion: Cluster endophthalmitis can be prevented by taking aseptic precautions. Delay in initiation of treatment results in poor visual outcome. However, quick and timely decision helps in early intervention which provides a better chance to salvage eye and vision. There are certain modifiable factors in camp surgery which should be addressed properly to improve the final outcome.
 

Keywords: Clinical features, Cluster endophthalmitis, Cataract surgery, Polymicrobial etiology.

How to cite : Rathi R, Rana R, Nema N, Maurya R P, Gaur N, Jain A, Patel S, Verma A, Subedar V, Cataract surgery clinical features, treatment and operational difficulties in management of cluster endophthalmitis. Indian J Clin Exp Ophthalmol 2024;10(1):37-44

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