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I. A. Chaudhry, E. Al-Harthi, F. A. Shamsi, H. Alkuraya, H. Al-Mezaine, H. Al-Dhibi, E. Elzaridi, M. Buhaimad, Y. O. Arat, W. Al-Rashed; Visual Outcome of Patients With Endogenous Endophthalmitis Presenting to a Tertiary Eye Care Center. Invest. Ophthalmol. Vis. Sci. 2009;50(13):6191.
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To describe visual outcome of patients with endogenous endophthalmitis (EE) in patients presenting to a tertiary eye care center (TEC).
Retrospective, non-comparative, consecutive case series of 40 patients with diagnosis of EE managed at King Khaled Eye Specilaist Hospital (KKESH), Riyahd, Saudi Arabia, a TEC over the past 15-years were reviewed for their demographic, predisposing causes, treatment and outcome.
The study included 45 eyes (20 OD, 15 OS, 5 OU; 24 male, 16 female; average age 53 years, range 1.5 year to 90 years). The presenting signs/symptoms included decreased vision in 39 (86.7%), pain in 37 (82.2%), swelling/echymosis in 26 (57.8%) and evidence of anterior chamber inflammation in the form of hypopeon in 25 (55.6%) eyes. Average duration of patient’s signs/symptoms prior to their presentation/referral to KKESH was 17 days (range 2 days to 90 days). The most frequent risk factors for developing EE included a long standing history of diabetes mellitus in 24 (60%), chronic hypertension or heart disease in 18 (45%), recent history of urinary tract infection, dental abscess, foot ulcer, cholecystitis or bronchopneumonia in 17 (42.5%) patients. Twenty-five (55.6%) eyes required intravitreous antibiotics/antifungal adminstration and 12 (26.7%) eyes required pars plana vitrectomy as an initial procedure or at some point after the establishment of diagnosis of EE. Positive cultures were found from 34 (75.6%) eyes; the most common Gram positive organisms being Staphylococcus and Streptococcus species recovered from 15 (33.3%) eyes. Among the 21 (52.5%) patients who presented with fever or septicemia, blood cultures were obtained from 17 (42.5%) and were found to have positive growth of micro-organisms from 6 (35.3%) patients. Klebsiella and Staphylococcus species were the most common organisms recovered from the blood cultures. Average follow-up was 2.5 years (range 1 week to 11 years). Final vision ranging from light perception to 20/20 was possible in only 9 (20%) eyes. Twenty-five (55.6%) eyes required evisceration or enucleation to treat ocular infection or achieve acceptable cosmeses. Pathological examination of enucleated eyes revealed evidence of necrotic retina as the cause of devastating visual outcome.
Very poor visual outcome of patients with EE presenting to a TEC is due to their chronic diseases process and late presentation for evaluation and treatment.
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