Abstract
Purpose: :
To evaluate the predisposing medical conditions, causative organisms, management, as well as visual and systemic outcomes in endogenous endophthalmitis.
Methods: :
An exhaustive system-wide search was done to identify all patients with a diagnosis of endopthhalmitis treated at Loma Linda University Medical Center from October 2002 to July 2008. Through retrospective chart review, 17 patients (21 eyes) were identified with endogenous endophthalmitis. Follow-up ranged from 7 days to 17 months.
Results: :
Systemic predisposing conditions were primarily diabetes (62%), malignancy (12%), and autoimmune disease (12%). The source of infection was most often bacteremia of uncertain source (35%), followed by meningitis, pneumonia, and urinary tract infection. The majority (88%) of the patients underwent pars plana vitrectomy and the remainder underwent vitreous biopsy without vitrectomy. All patients received intravitreal antibiotics. Six patients (36%) had positive vitreous cultures. Of these, Staphylococcus aureus (4/6) was the most common isolated organism. Other isolates included Candida, Coagulase negative staphylococcus, and Klebsiella/Enterobacter sp. Presenting visual acuity was 20/200 or lower in all patients. Final visual improvement of one or more lines was noted in three patients (18%). Visual acuity declined in six patients (35%). The most common visual complication was retinal detachment (35%). Corneal ulceration (1), subretinal abscesses(1), and intractable pain requiring enucleation were also seen. Three patients (18%) died within one month of diagnosis, and another within three years of diagnosis.
Conclusions: :
Contrary to other published series of endogenous endophthalmitis, our patient population was more likely to have bacterial isolates (instead of fungal) with a predominance of Staphylococcus aureus. Similar to the current consensus, we found that endogenous endophthalmitis is consistently associated with poor visual prognosis and high mortality.
Keywords: endophthalmitis • retina