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O.Z. Plous, A. Amirikia, C. Kim, J.E. Puklin; Clinical Findings in Culture Positive Endogenous Endophthalmitis at the Kresge Eye Institute . Invest. Ophthalmol. Vis. Sci. 2004;45(13):512.
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Purpose: To investigate the clinical features, predisposing factors, causative organisms, treatment methods and visual acuity outcomes in patients diagnosed with endogenous endophthalmitis (EE) at the Kresge Eye Institute. Methods: With IRB approval, a retrospective review of medical records was performed on patients diagnosed with endophthalmitis from January 1 1989 to June 1, 2003. Records with a diagnosis of culture proven EE were selected for review. Results: 403 records with a diagnosis of endophthalmitis were reviewed. 34 patients and 38 eyes were diagnosed with culture proven EE. The mean age at diagnosis was 50.9 years (range 27–80 years). 4 patients presented with bilateral EE. Of 34 unilateral EE patients, 53% involved the right eye and 47% involved the left eye. The most common presenting complaint was pain (21) followed by redness (16), decreased vision (13), floaters (11), and photophobia (6). 79% of patients had a history of malignancy and 62% had diabetes mellitus. 82% of patients previously received immunosuppressive therapy, 65% had prior IV catheter placement, 85% were on dialysis, and 53% were hospitalized at the time of diagnosis of EE. 76% of eyes had anterior chamber findings. Hypopyon was present in 29% of eyes. 18 patients had positive vitreous cultures only, 20 positive systemic cultures only, and 13 positive vitreous and systemic cultures. Vitreous culture organisms were C. albicans (39%, 7/18), S. aureus (22%, 4/18), and Fusarium spp. (17%, 3/18). Systemic blood cultures were positive in 44% (15/34) of patients, with S. aureus being most common (27%, 4/15), followed by C. albicans (13%, 2/15), Enterococcus spp. (13%%, 2/15), and K. pneumoniae (13%, 2/15). Initial treatment was tap and inject in 62% (21/34) of eyes or pars plana vitrectomy in 38% (13/34) of eyes. 6% (2/34) eyes were enucleated after initial tap and injection of antimicrobials. Initial visual acuity was better than 20/50 in 1 eye, 20/50–20/200 in 6 eyes, and less than 20/200 in 23 eyes. Final visual acuity was better than 20/50 in five eyes, 20/50–20/200 in 8 eyes, and less than 20/200 in 17 eyes. Four patients with initial visual acuity worse than 20/50 developed better than 20/50 vision after treatment with intravitreal and systemic antimicrobial therapy. Conclusions: EE is a visually devastating disease with poor visual prognosis, despite aggressive therapy. Important EE risk factors include dialysis, immunosuppressive therapy, malignancy, and diabetes mellitus. Culture isolates are almost equally divided between bacterial and fungal species.
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