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Factors of good visual outcome in acute post-cataract endophthalmitis (friends group)
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Edité par CCSD -
International audience. Purpose: To analyze initial clinical factors of good visual outcome in patients with acute endophthalmitis following cataract surgery. Methods: A prospective study was performed in 4 University hospital (Dijon, Grenoble, Lyon, Saint-Etienne, FRIENDS group) on 100 patients with acute post-cataract endophthalmitis. Factors related to cataract surgery (complications), the initial presentation and the microbiological identification were analyzed according to the final visual outcome using univariate and multivariate analysis (SPSS 12.0). Results: 46% out of the patients had a final visual acuity less than or equal to 0.3 logMar (good visual outcome) at 6 months while 10% had light perceptions. Patients with good visual outcome differed from the patients with poor final visual acuity for the duration of cataract surgery (p=0.05), initial visual acuity (> LP, p=0.005), the visibility of fundus (p=0.04) and the identification of a coagulase negative Staphylococcus (p=0.05). On the other hand, patients with a poor visual outcome (> 0.3 LogMAR) were older (p=0.004), had more frequently cornea oedema (p=0.05) and a larger hypopion (p=0.01) at admission, more frequently complications at the time of cataract surgery (p=0.005), and a bacterium was more frequently identified (p=0.005). Multivariate analysis showed that age, complications at the time of cataract surgery and identification of bacteria were independent factors of visual prognosis. Conclusions: Factors of visual outcome in acute postcataract endophthalmitis identified in this prospective study (2004-2007) were similar to those reported by the EVS 15 years ago. Given the bias associated with the therapeutic strategy, pars plana vitrectomy is associated with predictive factors of poor visual outcome. Identificaton of these predictive factors at presentation should allow a better identification of patients needed an aggressive treatment.
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