%0 Journal Article
%T Exogenous Endophthalmitis in Diabetic Patients: A Systemic Review
%A Georges M. El-Mollayess
%A Joanna S. Saadeh
%A Haytham I. Salti
%J ISRN Ophthalmology
%D 2012
%R 10.5402/2012/456209
%X Diabetes mellitus is a systemic disease that increases the risk of infections. Exogenous endophthalmitis is an inflammatory disease to which diabetic patients are more predisposed to than nondiabetic patients undergoing any intraocular intervention. This might be because of the change in the immune and inflammatory factors that intervene in wound healing and in the bacterial flora of the ocular adnexa. We conducted a literature review to assess the risk of exogenous endophthalmitis in diabetic patients undergoing cataract extraction, pars plana vitrectomy, and intravitreal injections and to check whether its treatment differ from in non-diabetics. We found that diabetic patients are more predisposed to virulent organisms and that the incidence of ophthalmic symptoms was not substantially different in diabetic versus nondiabetic patients. Regarding treatment, all patients with light perception should receive pars plana vitrectomy, while those with hand motion and better vision should be given an intravitreal antibiotics injection. Some authors recommend vitrectomy to diabetic patients with even counting figure vision. 1. Introduction Infectious endophthalmitis is defined as the infestation of the intraocular compartment by microorganisms. It represents one of the most severe and potentially devastating inflammatory reactions seen in the eye and it often results in irreversible visual loss [1, 2]. Based on the site of entry of this agent, endophthalmitis can be divided into an infection of either exogenous or endogenous origin. While the former condition most commonly occurs after intraocular surgery or trauma, the latter form is believed to be linked to septicemia. Postoperative bacterial endophthalmitis is a rare, but severe complication of intraocular surgery. The infecting bacteria by replication and release of toxins can damage the intraocular structures, and the inflammatory reaction of the host seems to contribute even further to the damage [3]. Patients with diabetes mellitus (DM) known to have an impaired immune response may be at a higher risk for developing postoperative infections. Effectively at the cellular and humoral levels, there is suboptimal response to different antigens in addition to altered phagocytic capabilities [4¨C7]. Moreover, it is established that impaired neutrophil bactericidal function is strongly associated with poor glycemic control [8, 9]. Furthermore, the tear film, the first immunological barrier for the ocular system, is altered in patients with DM. There is documented decrease in the breakup time and an established
%U http://www.hindawi.com/journals/isrn.ophthalmology/2012/456209/