Incidence and clinical features of endophthalmitis following open globe injury in Khatam-al-Anbia hospital, Mashhad

Purpose: The goal of this study was evaluation of the incidence rate of posttraumatic endophthalmitis, its clinical features and probable risk factors in repaired open globe injuries. Methods: In this retrospective case series, surgical and medical records of 600 patients with open globe injury were reviewed. Patients who underwent primary repair (as soon as possible) in Khatam-al-Anbia Eye Hospital, Mashhad, Iran, were included. Traumatic eye injuries were evaluated with respect to place of occurrence, age of patients, time interval between trauma and repair, damaged tissues, incidence of endophthalmitis, and its probable risk factors. Results: Endophthalmitis occurred in 25 patients (4.2%). The mean age of the patients was 23.5 year (SD=20.006). 76% of patients (456 cases) were males and 24% were females. 69.9% of injuries occurred in urban places (419 cases) and 181 cases were occurred in rural areas. Mean interval time between trauma and repair was 30.85 hour (SD=72.187), median was 9.5 hour, and 80.9% of cases repaired within first 24 hours. 32.3% of patients (193 cases) had traumatic cataract, vitreous prolapse occurred in 23.1% (139 cases), and 6.5% of cases (39 patients) had intraocular foreign body (IOFB). Sharp offending object and trauma in right eye were associated with significantly increased risk of endophthalmitis (P=0.009 and P=0.004 respectively), but age (P=0.336), gender (P=0.632), location in which trauma occurred [rural area (P=0.268)], vitreous prolapse (P=0.751) and IOFB (P=0.169) were not associated with statistically significantly increased risk of endophthalmitis. Intravitreous antibiotic had not been injected routinely. Endophthalmitis was more frequent in those who received intravitreal antibiotics, P=0.000. Conclusion: Incidence of endophthalmitis was 4.2%, which is comparable with previous studies. Trauma with sharp objects and right eye were associated with increased risk of endophthalmitis. Despite previous studies IOFB and rural areas did not increase the risk of endophthalmitis, possibly due to vitrectomy in these cases. Probably, because of short time interval between trauma and primary repair in most cases, lag to repair was not a risk factor for development of endophthalmitis. Intravitreous antibiotic was injected only in severely damaged eyes, therefore its prophylactic effect against endophthalmitis could not be evaluated in this study.