Post-traumatic endophthalmitis.

OBJECTIVE: To establish risk factors for the occurrence of post-traumatic endophthalmitis, to observe the efficacy of prophylaxis, and to describe the clinical features of post-traumatic endophthalmitis.

DESIGN: Partially prospective consecutive case-control study.

PARTICIPANTS: A total of 250 consecutive patients admitted to a single ophthalmic hospital with open globe injuries during a 3-year period were included.

METHODS: Patients with post-traumatic endophthalmitis were identified prospectively and added to an endophthalmitis database. All open globe injuries during the same time period were identified through a retrospective search of inpatient admissions, and their charts were reviewed. Information collected from all patient files included patient age; gender; injury setting (indoor/outdoor); wound contamination; nature of injury (site on eye, lens involvement, retained intraocular foreign body); mechanism of injury (penetration/perforation/rupture/ruptured surgical wound); prophylactic antibiotic administration, including route and timing; timing of primary repair; lensectomy at the time of primary repair; and depot corticosteroid at the time of primary repair. Any association between these parameters and the subsequent development of endophthalmitis was investigated. Any association between endophthalmitis and final visual acuity (VA) and also enucleation was evaluated.

MAIN OUTCOME MEASURE: Development of endophthalmitis.

RESULTS: The frequency of endophthalmitis after open globe injury was 6.8%. The following factors were associated with the subsequent development of endophthalmitis by univariate analysis: dirty wound (14.3% vs. 4.1%, P = 0.01), retained intraocular foreign body (13.0% vs. 4.4%, P = 0.02), lens capsule breach (12.8% vs. 3.2%, P = 0.01), delayed primary repair (> or =12 hours) (11.3% vs. 2.9%, P = 0.02), and rural address (10.1% vs. 4.3%, P = 0.07). Risk factors identified after multivariate analysis were dirty injury (odds ratio [OR], 5.3; 95% confidence interval [CI)], 1.5-18.7), breach of lens capsule (OR, 4.4; 95% CI, 1.2-15.6), and delay in primary repair (per hour: OR, 1.013; 95% CI, 1.002-1.024). None of the following factors was found to be associated with post-traumatic endophthalmitis: patient age, gender, injury setting, site of injury on eye, mechanism of injury, antibiotic administration, lensectomy at the time of primary repair, and depot corticosteroid at the time of primary repair. Final VA tended to be worse in eyes with endophthalmitis (P = 0.08). Endophthalmitis did not significantly influence the frequency of enucleation/evisceration (5.9% vs. 4.3%, P = 0.55).

CONCLUSIONS: Delay in primary repair, ruptured lens capsule, and dirty wound were each independently associated with the development of post-traumatic endophthalmitis. Patients with > or =2 of these 3 risk factors had a particularly high frequency of infection.