Postoperative Endophthalmitis and Intraocular Vancomycin

Abstract

This study reviewed 570 consecutive corneal transplants done in one hospital by one ophthalmologist. In 480 of these transplants, vancomycin, 1 mgm/BSS 1 ml, was used to store the donor cornea for 5–10 minutes after removal from Optisol or Optisol GS and as an irrigating solution throughout the procedure. Ninety donors stored in Optisol only were used as a control. The vancomycin solution also was used to fill the anterior chamber, posterior chamber, and vitreous cavity, when indicated, at the end of surgery. Donor rims stored in the vancomycin/BSS before transplantation had 5% positive cultures. Prior to vancomycin immersion 16.6% of donor rims grew bacteria. The decrease to 5% is statistically significant (p = 0.00036). Vancomycin/BSS storage reduced the incidence of streptococcus cultured from the donor from 3.3% to 0.2%. The study found that 0.6% (3/480) patients with vancomycin treated corneas developed postoperative endophthalmitis. All of their donor cultures were negative. Three additional eyes developed endophthalmitis following suture adjustment (0.6%). Previous lens surgery, glaucoma, regrafting, and postoperative suture manipulation were found to be associated with postoperative endophthalmitis. In the nonvancomycin eyes, two eyes (2.2%) developed endophthalmitis.