gms | German Medical Science

Introduction: Once and again, there are clusters of endophthalmitis patients. We want to present such a cluster of patients who were operated upon on the same day by the same surgeon and all of them developed endophthalmitis due to Empedobacter brevis.

Patients and Methods: Twelve patients were referred because of endophthalmitis after cataract extraction. Patients were followed-up in the ophthalmology unit of the University of Freiburg or by the referreing ophthalmologists. There was an environment exam in the institution where the outbreak had occurred.

Results: The patients (5 male, 7 female, mean age 75y) presented 1 to 6 days after uncomplicated cataract extraction. There was no association between medical or ophthalmological diseases and the severity of the endophthalmitis. Four patients were treated by anterior chamber lavage and intravitreal antibiotics; three of them later required vitrectomy. Seven patients needed primary vitrectomy which had to be repeated in three with additional lens extraction in two. One patient had vitrectomy including lens extraction as a primary procedure. There were two postoperative retinal detachments which required silicon oil ± encircling band. Mean visual acuity rose from 0.02 to 0.47 nine months later. Empedobacter brevis was found in the anterior chamber and in the vitreous. The source of the outbreak could not be determined with certainty.

Discussion: In high volume cataract surgery endophthalmitis endemia is always a risk. Sources of infection may be anything. Patients do not react homogenously probably because of different extent of inocculation and individual disposition. Prompt aggressive treatment by vitreous surgery may lead to favourable results.