Abstract

SO.20.05

Diagnostics in endophthalmitis

Neß T.
Universitäts-Augenklinik Freiburg

Objective: Infectious endophthalmitis is a serious complication of intraocular surgery, perforating injury or septic dissemination. Detection of the causative microorganism is essential for treatment.
Results: Publicated positive culture rate varied from 30% to 95%. To achieve high positive rate of detection of microorganism all material necessary to set up a culture has to be available in the operation theatre. Important is a variety of appropriate culture media: we use Columbia-, hematin-, modified ENDO- and yeast-cystein blood plates as well as a nutrient solution. Samples must applied to the culture media directly inside of the operation theatre. Is no immediate transport to a special laboratory possible, media should be cultured in the eye hospital under optimal conditions. Concurrently, undiluted samples should be used for eubacterial PCR. While standard PCR can only detect the causative microorganism, standard culture procedures provide additionally information about resistance to antimicrobiologic therapies. In the case of presumed fungal endophthalmitis the collected vitrectomy fluid has to be centrifuged and thereafter to be cultured. In presumed endogenous endophthalmitis also extraocular samples should be examined, e.g. blood culture and smears from other sides of infection.
Conclusions: With these approaches, a detection rate of more than 90% can be achieved in patients with endophthalmitis.

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