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N. S. Chandrasekaran, T. Eck, D. Chu, P. Hersh, M. Zarbin, N. Bhagat; Characteristics of Eyes With Infectious Keratitis Related Endophthalmitis With No Light Perception Visual Acuity. Invest. Ophthalmol. Vis. Sci. 2010;51(13):6045.
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© ARVO (1962-2015); The Authors (2016-present)
To describe the characteristics of eyes with keratitis related infectious endophthalmitis that presented with no light perception (NLP) visual acuity (VA).
Retrospective chart review of all cases of keratitis related endophthalmitis between 1997 and 2008 at NJMS with NLP VA.
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).
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.
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