Purchase this article with an account.
Nicole Siegel, Achal Patel, Deeba Husain; Clinical Features and Treatment Outcomes of Endogenous Endophthalmitis. Invest. Ophthalmol. Vis. Sci. 2013;54(15):1101.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
To review the risk factors, clinical features, prognostic factors, treatment and outcomes of patients diagnosed with endogenous endophthalmitis at Boston Medical Center.
The medical records of patients diagnosed with endogenous endophthalmitis between 2005 and 2012 were reviewed. Variables included age, gender, existing medical conditions, systemic infections, ocular infections, immune status, risk factors and treatment.
Endogenous endophthalmitis was diagnosed in 14 patients and the charts of 12 patients were evaluated. One patient had bilateral involvement, 6 (50%) involved the right eye and 5 (41.7%) the left eye. The mean age at diagnosis was 49.5 years (range 24 to 80), with 5 (41.7%) patients under the age of 35 years. Seven patients (58.3%) were female and 5 (41.7%) were male. Four (33%) had a previous diagnosis of Hepatitis C and 2 (16.6%) had decreased mental status on presentation. None of the patients had HIV. The most common risk factor, intravenous drug use, was seen in 6 (50%) of the patients. Five (41.7%) initially presented with best corrected visual acuity (BCVA) of counting fingers and improved to a BCVA between 20/50 and 20/400. The majority of ocular cultures yielded no growth. Five (41.7%) of the patients had a presumed or culture positive Candida spp. infection. 1 (8.3%) was culture positive for Serratia marcescens, 2 (16.6%) had presumed methicillin-resistant Staphylococcus aureus and 4 (33%) did not have a known infection or culture diagnosis. Seven (58.3%) patients had cardiac imaging with transthoracic and/or transesophageal echocardiography but no study revealed vegetations. Seven (58.3%) patients underwent a pars plana vitrectomy. Two (16.6%) patients were ultimately treated with evisceration of the affected eye secondary to panophthalmitis on presentation.
Endogenous endophthalmitis can have a devastating visual outcome and most commonly occurs in patients with underlying medical conditions such as diabetes, septicemia or immunosuppression. In contrast, intravenous drug use was the most prevalent risk factor in our series, especially those under the age of 40. The diagnostic yield of cardiac imaging to evaluate for endocarditis is unclear in this setting, especially in the absence of cardiopulmonary symptoms. A thorough skin examination may be warranted at the time of diagnosis, as 2 (16.6%) patients presented with skin abscesses requiring treatment.
This PDF is available to Subscribers Only