Purchase this article with an account.
J. Pearlman, M. Gill; Endogenous Endophthalmitis: A 17–Year Review of Cases At an Academic Hospital . Invest. Ophthalmol. Vis. Sci. 2005;46(13):5557.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Purpose: To investigate patient characteristics, predisposing conditions, pathogens, initial diagnosis, definitive treatment, and outcomes of patients with endogenous endophthalmitis. Methods: Retrospective chart review of endogenous endophthalmitis cases from 1988–2004. Results: Of the 18 cases, there were 12 men and 6 women with a mean age of 57 years (range 32–76). 33% of cases were bilateral. Vision on presentation was 20/20–20/100 in only 24% of patients, with the majority of patients (56%) finger counting or worse on presentation. Almost 2/3 (61%) were associated with a predisposing condition: DM (22%), HIV/AIDS (17%), malignancy (11%), post–transplant immunosuppression (6%) and renal failure (6%). 3 of 18 (17%) of patients were initially misdiagnosed. The vast majority (89%) of patients had positive blood and/or IV line cultures, with only 22% having a positive AC tap and 17% with positive vitreous cultures. The most common causative organisms were S. aureus (39%) various Strep spp. (34%), and fungal organisms (22%). Extraocular foci of infection included cardiac (22%), brain (11%), skin (11%), lung, joints, and urinary tract. Initial treatment included: systemic antibiotics or antifungals in 89%, intravitreal antibiotics or antifungals in 39%, removal of the infected IV line in 22%, and topical steroids in 22%. Almost a quarter (22%) of patients had subsequent pars plana vitrectomy and another 22% had a scleral buckle. Only 30% of patients maintained a vision 20/80 or better after treatment, and 45% were finger–counting or worse. Conclusions: In our study, endogenous endophthalmitis affected relatively young patients, men more frequently than women, with a full third of cases bilateral and the majority associated with extraocular foci of infection. Unfortunately, initial misdiagnosis was not uncommon (17%), leading to delayed treatment. An increased index of suspicion is necessary, especially in patients with predisposing conditions such as diabetes, malignancy, HIV and systemic immunosuppression. The most frequent isolates were Staph and Strep, followed by fungals, and visual outcomes were poor.
This PDF is available to Subscribers Only