gms | German Medical Science

102. Jahrestagung der DOG

Deutsche Ophthalmologische Gesellschaft e. V.

23. bis 26.09.2004, Berlin

Prognosis and therapy of Endophthalmitis: a retrospective analysis

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  • corresponding author A.M. Joussen - Department of Vitreoretinal Surgery, University of Cologne, Cologne
  • H. Llacer - Department of Vitreoretinal Surgery, University of Cologne, Cologne
  • B. Kirchhof - Department of Vitreoretinal Surgery, University of Cologne, Cologne

Evidenzbasierte Medizin - Anspruch und Wirklichkeit. 102. Jahrestagung der Deutschen Ophthalmologischen Gesellschaft. Berlin, 23.-26.09.2004. Düsseldorf, Köln: German Medical Science; 2004. Doc04dogFR.15.09

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Veröffentlicht: 22. September 2004

© 2004 Joussen et al.
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The endophthalmitis vitrectomy study (EVS) demonstrated that there was no difference in outcome between immediated vitrectomy and intraocular antibiotics alone of the initial vision was hand movcements or better. This is in disagreement with our clinical experience. We have therefore retrospectively analyzed the data of 66 consecutive patients from 1999-2003 in the cologne eye hospital and compared with the EVS results.


All patients received intravenous antibiosis or antifungal treatment, a vitrectomy and an additional intravitreal application of Ceftazidim und Vancomycin, Prednisolone and Amphothericin B in cases of a suspected fungal infection. 93 patients were additionally treated with intravitreal injections, in 85% in combination with a vitrectomy. The value of vitrectomy was analyzed with respect to final visual acuity and the rate of postoperative complications.


Bacterial infection was found in 39% of the patients (37% gram positive bacteria, 2% gram-negative bacteria), a fungal infection was present in 14% of the cases, a mixed infection in 5%. A visual acuity of 20/400 or better upon deferral could be obtained in 43% of the patients (in 28 % of cases after cataract surgery, in 8 % after other intraocular surgeries, and in 6% of patients with endogenous endophthalmitis, in 0% after severe eye injury). Ambulatory vision (20/800-LSP) could be attained in patients with visual acuity of worse than hand movements at the initial presentation. Hypotony was apparent in 3% of the patients, one eye after severe fungal endophthalmitis was enucleated.


The pre- and postoperative visual acuity was comparable to the ETS. However, in comparison to the VIT group of the ETS, the rate of phthitic eyes was smaller (3% vs. 7.9%). Emphasis should be made that the immediate vitrectomy allows for better postoperative control of the infection. Furthermore, the rate of re-operations (pucker peeling, vitrectomy for vitreous opacities) seems to be superior to intravitreal injection alone.