Abstract
Purpose: :
To describe the characteristics of eyes with keratitis related infectious endophthalmitis that presented with no light perception (NLP) visual acuity (VA).
Methods: :
Retrospective chart review of all cases of keratitis related endophthalmitis between 1997 and 2008 at NJMS with NLP VA.
Results: :
19 eyes (19 patients) were identified. 10 of 19 patients were male. Average age at presentation was 67 years. Race distribution included: 5 African American, 4 White, 3 Asian, 2/19 Hispanic and in 5 race was not reported. 95% (18/19) of patients had a corneal ulcer and 9 of those 18 had perforated ulcer at presentation. The remaining 1 patient had fungal keratitis status post penetrating keratoplasty (PKP). 21% (4/19) of patients had a history of PKP. 47% (9/19) were phakic, 32% (6/19) pseudophakic and 21% (4/19) aphakic. 53% (10/19) of patients had a retinal detachment. 12 of the 19 patients underwent diagnostic cultures at time of presentation; 2 of the 12 underwent vitreous and corneal cultures and 10 underwent either vitreous or corneal cultures; only 79% of cultures taken were positive. The most common cultured organism was pseudomonas aeruginosa (2/11). The other organisms included streptococcus pneumonia, morganella morganii, serratia marascens, staphylococcus epidermidis, propionibacterium acnes, and MRSA. There was 1 positive fungal culture for fungal hyphae. 89% (17/19) of eyes underwent enucleation, of which 15 (88%) underwent cultures of intraocular contents. Only 3 (20%) had positive cultures. 14 of the 19 patients (74%) were admitted to the hospital for treatment, with an average stay of 4.6 days (range 1-10 days). Treatments included IV antibiotics only (11/14), IV and intravitreal antibiotics (2/14), and IV and oral antibiotics (1/14). The most common IV antibiotic regimen included vancomycin and ceftazadime in 36% of patients. Voriconazole was used for one patient with fungal keratitis. 12 of 14 admitted patients were enucleated during their hospital stay. The remaining 5 of 19 eyes were scheduled for enucleation and treated as outpatients with either topical or oral antibiotics. The average time between diagnosis of endophthalmitis and treatment with enucleation was 4 days (range 0-23).
Conclusions: :
In our series, 89% (17/19) of NLP eyes with infectious keratitis and endophthalmitis underwent enucleation. Of the 2 remaining eyes, one had a final visual acuity of NLP and the other only light perception.
Keywords: endophthalmitis • keratitis