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Mehrdad Malihi, Shriji Patel, Thomas Eck, Marco A Zarbin, Neelakshi Bhagat; Corneal Ulcer Associated Endophthalmitis: Review of Cases in University Hospital from 2001-2012. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):4188.
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Prior studies have shown that infectious keratitis uncommonly progresses to endophthalmitis, with guarded visual prognosis. We performed a retrospective, observational clinical study to learn more about the demographics, clinical course, microbiology, associated factors and visual outcomes of patients with infectious keratitis related endophthalmitis.<br />
Retrospective case series of all patients treated for corneal ulcer associated infectious endophthalmitis between January 1, 2001 and December 31, 2012 at the University Hospital, Rutgers University.<br />
Twenty four cases with corneal ulcer associated endophthalmitis were identified from 2001 to 2012 (12 male and 12 females), with a mean age of 65.9±19.9. Mean follow up time was 21± 40 weeks. Lens status was phakic in 54.1%, pseudophakic in 41.7% and aphakic in 4.2%. Diabetes was present in 62.5% of the cases, and 54.2% had a history of major intraocular surgery. Average time from start of ulcer symptoms to diagnosis of endophthalmitis was 11.8 ± 15.0 days; 58% of the patients were on topical antibiotics before the diagnosis was made. Fourteen of the cases presented with no light perception vision and were primarily enucleated. These enucleated eyes were culture positive for gram positive organisms in 5 (35.7%), gram negatives in 3 (21.4%), fungi in 1 (7.2%) and no growth or unknown in 5/24 (35.7%) of cases. In the remaining ten cases, visual acuity ranged from 20/60 in one case to HM in five and LP in 4 cases. The microbiology evaluation revealed gram positive organisms in 5 (50.0%), gram negatives in 2 (20.0%), fungi in 1 (10.0%), atypical mycobacterium in 1(10.0%) and no growth in 1 (10%) of cases. Intravitreal injection of antibiotics was performed in all the ten cases that were not primarily enucleated at the diagnosis of endophthalmitis (average 1.6 injections per case during the course of treatment). Pars plans vitrectomy with vitreous biopsy was performed In 5 (50%) cases, and emergency corneal transplantation was performed on 4 cases (40%). Two of the eyes were secondarily enucleated; two became NLP but were not enucleated, and final visual acuity was LP in one, HM in two, CF in one and 20/50 in two cases.
Eyes with infectious keratitis related endophthalmitis, in this series, had a poor visual outcome with a high rate of NLP and enucleation.
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