Impact of cultures on management decisions following surgical repair of penetrating ocular trauma.

BACKGROUND AND OBJECTIVE: The purpose of this study was to evaluate the utility of routine bacterial and fungal cultures in the diagnosis of endophthalmitis and in the subsequent management of patients following penetrating ocular trauma. PATIENTS AND METHODS: The medical records of 70 consecutive patients with penetrating ocular trauma for whom intraoperative bacterial and fungal cultures had been obtained from the wound, aqueous, vitreous, and/or intraocular foreign body (IOFB) were retrospectively reviewed. The incidences of infection among eyes with and without a clinical diagnosis of infection were compared. A determination as to change in clinical management (change of antibiotic, length of treatment) was made. RESULTS: Twenty of 70 patients (29%) had positive cultures of the wound, aqueous, vitreous, and/or IOFB. Nine (13%) of the 70 patients were diagnosed as having endophthalmitis, based on clinical findings at presentation and during the subsequent clinical course. Seven (78%) of these 9 patients with a clinical diagnosis of endophthalmitis had positive cultures. The remaining 61 eyes showed no evidence of clinically apparent infections, despite positive cultures from 13 eyes (21%). Microbiologic data derived from the culture results influenced the clinical management of all 7 patients with endophthalmitis. Culture results (positive or negative) did not alter clinical decisions in eyes without clinical evidence of infection. CONCLUSION: Bacterial or fungal cultures obtained from the eye in the setting of penetrating trauma often had growth of organisms without clinical signs of infection. Positive culture results directly influenced management decisions in cases with clinically evident endophthalmitis. However, routine intra-operative bacterial cultures did not help to identify patients in whom endophthalmitis would develop, nor did they assist in directing management decisions in eyes without clinical suspicion of infection.

Duke Scholars

Author Scott William Cousins Ophthalmology, Vitreoretinal Diseases & Surgery