Endogenous Endophthalmitis: Analysis of Patient Characteristics and a Treatment Protocol at a Tertiary Care Medical Center

Abstract

Abstract: : Purpose: Endogenous endophthalmitis is a rare condition that most often results in loss of useful vision and presents a diagnostic and therapeutic challenge. We have seen a recent high incidence of endogenous endophthalmitis at our tertiary care center. We present the patient characteristics, treatment method, and results of our treatments. Methods: Retrospective chart review. Data was collected from a 2 year period in which 14 eyes of 9 patients were diagnosed and treated for endogenous endophthalmitis. Initial treatment in all patients included microvitrectomy at bedside for vitreous culture, anterior chamber paracentesis and culture, and intravitreal injection of antibiotics (vancomycin and ceftazidime) and dexamethasone. Additional intravitreal antibiotic injections were given in eyes with poor initial response. Vitreoretinal surgery was reserved for secondary retinal detachment or severe worsening of condition. Results: All patients were found to have bacterial endogenous endophthalmitis with a preponderance of gram positive organisms (89% of patients). Blood cultures were positive in all 9 patients. Intraocular cultures were positive in 5 of 14 (36%) eyes. Extraocular foci of infection were found in 56% of patients. 3 of 9 (33%) patients died as a result of underlying medical conditions. Final visual acuity among survivors was 20/200 or better in 7 of 10 eyes (70%), which compares favorably with previously reported reviews (range 19%–59%). Conclusions: Endogenous endophthamitis remains a difficult to manage condition. Patients in our study were treated with initial microvitrectomy and aggressive intravitreal antibiotic injections. Final visual acuity in our study compared favorably with previously reported reviews.

Keywords: endophthalmitis • bacterial disease • clinical (human) or epidemiologic studies: outcomes/complications