Traumatic endophthalmitis with intraocular metallic foreign body
, 1, 1
Abstract
Background: Post-traumatic endophthalmitis with retained intraocular foreign body is a severe complication of
open globe injuries. It is generally associated with poor visual outcome and requires prompt and adapted management.
Case report: A 39-year-old male patient presented with open globe injury of the right eye due to a metallic foreign
body projection. He was a victim of a neglected work accident 10 days ago when hammering a metallic bar. Visual
acuity on admission was LP (+) in the right eye. The Slit-lamp examination revealed perikeratic injection, edematous
cornea and severe inflammation of the anterior chamber with hypopyon. Ocular ultrasound showed a heterogeneous
vitreous organization compatible with a vitreous abscess. Orbito-cerebral CT scan revealed a retained intraocular
metallic foreign body located in the posterior segment, within the vitreous humor. The patient received local and
general antibiotherapy associated with intravitreal injections of vancomycin and ceftazidime followed by a vitrectomy
to remove the intraocular foreign body. The visual outcome was poor with an evolution towards phtysis bulbi. The
aim of this case report is to study the risk factors of post-traumatic endophthalmitis with retained intraocular foreign
body and to examine treatment principles and visual outcome of this severe complication.
Keywords: traumatic endophthalmitisintraocular foreign bodyposterior segmentrisk factorintravitreal antibioticvitrectomy
References
- Williams DF, Mieler WF, Abrams GW, et al. Results and prognostic factors in penetrating ocular injuries with retained intraocular foreign bodies. Ophthalmology. 1988; 95(7): 911–916.
- Azad R, Ravi K, Talwar D, et al. Pars plana vitrectomy with or without silicone oil endotamponade in post-traumatic endophthalmitis. Graefes Arch Clin Exp Ophthalmol. 2003; 241(6): 478–483.
- Kong GYX, Henderson RH, Sandhu SS, et al. Wound-related complications and clinical outcomes following open globe injury repair. Clin Exp Ophthalmol. 2015; 43(6): 508–513.
- Kuhn F, Morris R, Witherspoon CD, et al. The Birmingham Eye Trauma Terminology system (BETT). J Fr Ophtalmol. 2004; 27(2): 206–210.
- Boldt H, Pulido J, Blodi C, et al. Rural Endophthalmitis. Ophthalmology. 1989; 96(12): 1722–1726.
- ESSEX R, YI Q, CHARLES P, et al. Post-traumatic endophthalmitis. Ophthalmology. 2004; 111(11): 2015–2022.
- Soheilian M, Rafati N, Mohebbi MR, et al. Prophylaxis of acute post-traumatic bacterial endophthalmitis: a multicenter, randomized clinical trial of intraocular antibiotic injection, report 2. Arch Ophthalmol. 2007; 125(4): 460–465.
- Dehghani AR, Rezaei L, Salam H, et al. Post traumatic endophthalmitis: incidence and risk factors. Glob J Health Sci. 2014; 6(6): 68–72.
- Yang CS, Lu CK, Lee FL, et al. Treatment and outcome of traumatic endophthalmitis in open globe injury with retained intraocular foreign body. Ophthalmologica. 2010; 224(2): 79–85.
- Jonas JB, Knorr HL, Budde WM. Prognostic factors in ocular injuries caused by intraocular or retrobulbar foreign bodies. Ophthalmology. 2000; 107(5): 823–828.
- Woodcock MGL, Scott RAH, Huntbach J, et al. Mass and shape as factors in intraocular foreign body injuries. Ophthalmology. 2006; 113(12): 2262–2269.
- Cebulla CM, Flynn HW. Endophthalmitis after open globe injuries. Am J Ophthalmol. 2009; 147(4): 567–568.
- Woodcock MGL, Scott RAH, Huntbach J, et al. Mass and shape as factors in intraocular foreign body injuries. Ophthalmology. 2006; 113(12): 2262–2269.
- Chaudhry IA, Shamsi FA, Al-Harthi E, et al. Incidence and visual outcome of endophthalmitis associated with intraocular foreign bodies. Graefes Arch Clin Exp Ophthalmol. 2008; 246(2): 181–186.
- Jonas JB, Budde WM. Early versus late removal of retained intraocular foreign bodies. Retina. 1999; 19(3): 193–197.
- Colyer MH, Weber ED, Weichel ED, et al. and al. Delayed intraocular foreign body removal without endophthalmitis during Operations Iraqi Freedom and Enduring Freedom. Ophthalmology. 2007; 114(8): 1439–1447.
- Ferrari TM, Cardascia N, Di Gesù I, et al. Early versus late removal of retained intraocular foreign bodies. Retina. 2001; 21(1): 92–93.
- Narang S, Gupta V, Simalandhi P, et al. Paediatric open globe injuries. Visual outcome and risk factors for endophthalmitis. Indian J Ophthalmol. 2004; 52(1): 29–34.
- Sabaci G, Bayer A, Mutlu FM, et al. Endophthalmitis after deadly-weapon-related open-globe injuries: risk factors, value of prophylactic antibiotics, and visual outcomes. Am J Ophthalmol. 2002; 133(1): 62–69.
- Bhagat N, Nagori S, Zarbin M. Post-traumatic Infectious Endophthalmitis. Surv Ophthalmol. 2011; 56(3): 214–251.
- Gokce G, Sobaci G, Ozgonul C. Post-Traumatic Endophthalmitis: A Mini-Review. Semin Ophthalmol. 2015; 30(5-6): 470–474.
- Thompson WS, Rubsamen PE, Flynn HW, et al. Endophthalmitis after penetrating trauma. Risk factors and visual acuity outcomes. Ophthalmology. 1995; 102(11): 1696–1701.
- Duch-Samper AM, Menezo JL, Hurtado-Sarrió M. Endophthalmitis following penetrating eye injuries. Acta Ophthalmol Scand. 1997; 75(1): 104–106.
- Zhang Y, Zhang MN, Jiang CH, et al. Endophthalmitis following open globe injury. Br J Ophthalmol. 2010; 94(1): 111–114.
- El Chehab H, Renard JP, Dot C. [Post-traumatic endophthalmitis]. J Fr Ophtalmol. 2016; 39(1): 98–106.
- Baum J, Peyman GA, Barza M. Intravitreal administration of antibiotic in the treatment of bacterial endophthalmitis. III. Consensus. Surv Ophthalmol. 1982; 26(4): 204–206.
- Chhabra S, Kunimoto DY, Kazi L, et al. Endophthalmitis after open globe injury: microbiologic spectrum and susceptibilities of isolates. Am J Ophthalmol. 2006; 142(5): 852–854.
- Narang S, Gupta V, Gupta A, et al. Role of prophylactic intravitreal antibiotics in open globe injuries. Indian J Ophthalmol. 2003; 51(1): 39–44.
- Kresloff MS, Castellarin AA, Zarbin MA. Endophthalmitis. Surv Ophthalmol. 1998; 43(3): 193–224.
- Peyman GA, May DR, Homer PI, et al. Penetration of gentamicin into the aphakic eye. Ann Ophthalmol. 1977; 9(7): 871–880.
- Theodore FH. Bacterial Endophthalmitis after Cataract Surgery. Int Ophthalmol Clin. 1964; 4: 839–859.
- Park SS, Samiy N, Ruoff K, et al. Effect of intravitreal dexamethasone in treatment of pneumococcal endophthalmitis in rabbits. Arch Ophthalmol. 1995; 113(10): 1324–1329.
- Mittra RA, Mieler WF. Controversies in the management of open-globe injuries involving the posterior segment. Surv Ophthalmol. 1999; 44(3): 215–225.
- Abu el-Asrar AM, Tabbara KF. Clostridium perfringens endophthalmitis. Doc Ophthalmol. 1994; 87(2): 177–182.
- Azad R, Ravi K, Talwar D, et al. Pars plana vitrectomy with or without silicone oil endotamponade in post-traumatic endophthalmitis. Graefes Arch Clin Exp Ophthalmol. 2003; 241(6): 478–483.
- Bali E, Huyghe Ph, Caspers L, et al. Vitrectomy and silicone oil in the treatment of acute endophthalmitis. Preliminary results. Bull Soc Belge Ophtalmol. 2003(288): 9–14.
- Siqueira RC, Gil AD, Canamary F, et al. Pars plana vitrectomy and silicone oil tamponade for acute endophthalmitis treatment. Arq Bras Oftalmol. 2009; 72(1): 28–32.