Management of Endophthalmitis at the IOTA University Hospital Center (CHU-IOTA)

Abstract

Introduction: Endophthalmitis represents a rare but serious damage to the eyeball, potentially blinding, leading in most cases to a significant or permanent reduction in visual acuity. They mainly affect active people and can occur after regular eye surgery, endogenous eye trauma or by contiguity. They sometimes involve the anatomy of the globe. Methodology: This was a prospective and descriptive study running from January 1 to June 30, 2020 and covering all patients aged over 10 years consulting for endophthalmitis at IOTA University Hospital. The general objective was to study the management of endophthalmitis. Result: In total, 55 cases out of 20,843 patients were identified, i.e. a frequency of 0.26%. The average age was 39 years with a range of 10 to 74 years. The sex ratio was 1.3. Ocular trauma was the most common etiology found in 78.2%. Gram-positive germs were found in 47.3%. In total, 51 eyes or 92.8% were anatomically preserved and four eyes were eviscerated or 7.2%. The anatomical result at the end of the treatment was satisfactory in 92.8%. On admission, all our patients had visual acuity less than 1/10. Patients had visual acuity of 1-3/10 in 36.4% and greater than 3/10 in 16.4% after treatment. Endophthalmitis was complicated by iris hernia with 12.7%. Discussion: Ocular trauma represented the highest frequency, i.e. 78.2%. This result is higher than that of Chehab H. et al. [1] who found a frequency of 13% in his study. Endophthalmitis after cataract surgery represented 16.4%. This result is significantly higher than that of Chérif T. and Isabelle C. [3] who found 0.014%.  Endogenous etiology was represented in 5.4%.  Landré C. and Baillif S. [9] found 6.20% of endogenous cause out of 323 cases in their study. On admission, 100% of our patients had visual acuity less than 1/10; the most common signs were pain and decreased visual acuity (BAV).  Marcil S. et al. had found BAV, pain in all patients. FRIENDS group. [8] also reported 100% BAV and 60% ocular pain. Thus, we witnessed a significantly favorable evolution of this visual acuity 90 days after initiation of treatment. Conclusion: Endophthalmitis, an ophthalmological emergency, is a potentially blinding intraocular infection. Early treatment, adapted to the antibiogram, would be decisive for a better anatomical and functional prognosis.