Alan N. Carlson, M.D., Professor of Ophthalmology at the Duke Eye Center comments on the report below addressing better outcomes may be observed with delayed-onset endophthalmitis after cataract surgery.  “Delayed-onset needs to be further stratified or sub-grouped into the timing of the inoculation.  Primary inoculation of an indolent organism will have a different course than the delayed inoculation of a virulent organism resulting from ocular trauma or from a glaucoma filtering bleb.”

Superior initial visual acuities, fewer cases of hypopyon and better visual outcomes may occur in patients with delayed-onset endophthalmitis as opposed to those with acute-onset endophthalmitis, a study found.

The retrospective, consecutive case series included 118 patients treated between 2000 and 2009. Twenty-six were delayed-onset cases, occurring more than 6 weeks after cataract surgery, and 92 were acute-onset cases, occurring at 6 weeks or less after surgery.

Presenting visual acuity was 5/200 or less in 31% of delayed-onset cases vs. 89% of acute-onset cases; hypopyon presented in 46% vs. 80%, respectively. Propionibacterium acnes was the most popular isolate in the delayed-onset group, occurring in 11 of 26 patients, while coagulase-negative Staphylococcus was the most popular for acute-onset cases, presenting in 57 of 92 patients.

The two isolates were associated with the best visual acuity outcomes in each group; patients achieved 20/100 or better vision in 91% of delayed cases and 56% of acute cases.

The study was limited by variability between multiple physicians, as well as its retrospective nature and small sample size.