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Heeyoon Cho, Nicole Hauptman Siegel, Hyeong Gon Yu, Lucia Sobrin, Achal Patel, Han Woong Lim, Marlene Durand, Joan W Miller, Deeba Husain; Endogenous Endophthalmitis in the American and Korean Population : An Eight-year Retrospective Study. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):4169.
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To study the clinical features, epidemiological factors and treatment outcomes of endogenous endophthalmitis and compare these characteristics in sample patient populations from the United States and Korea over an eight-year period
We conducted a retrospective chart review of patients diagnosed with endogenous endophthalmitis from January 2006 to December 2013, who were referred to tertiary referral centers in the United States and South Korea. We compared clinical characteristics between Korean and American patients. We also compared the visual outcomes in patients who underwent vitrectomy vs. those who did not have a vitrectomy.
128 eyes of 108 patients with endogenous endophthalmitis were included. Sixty patients were American and 41 patients were Korean. Fungemia related to illicit intravenous drug use or an indwelling central venous catheter was a more common extraocular infection source among American patients than in Korean patients (26.7% vs. 6.3%, p=0.006). In contrast, liver abscess was overwhelmingly more common among Korean patients vs. American patients (33.3% vs 0%). Gram negative bacteria, especially Klebsiella pneumoniae, was the most common causative organism of endogenous endophthalmitis in the Korean population, whereas fungi were the most common etiologies in the American population. Among the 65 eyes with endogenous bacterial endophthalmitis(EBE), 13 eyes underwent immediate vitrectomy within 24 hours after diagnosis; 31% of these cases had presenting visual acuity of LP while only 15% had >CF. In contrast, 52% of the no vitrectomy group had >CF vision on presentation. There was no significant difference in the final visual outcome or degree of visual improvement between the vitrectomy group and the no-vitrectomy group. The final visual acuities of EBE were 20/50 or better in 17(26.2%) of 65 eyes. Endophthalmitis cases caused by fungi had a better visual prognosis than those caused by bacteria (p<0.001).
The predisposing conditions and responsible organisms for endogenous endophthalmitis varies in different regions of the world. Although endogenous endophthalmitis is generally associated with poor visual acuity outcomes, the prognosis appears to depend mainly on the pathogen. Early vitrectomy was not associated with a better visual prognosis in this study, but results were confounded by presenting visual acuity and pathogen virulence.
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