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V. Schiedler, I.U. Scott, M.S. Benz, H.W. Flynn Jr, D. Miller; Culture-Proven Endogenous Endophthalmitis: Clinical Features, Potential Predisposing Factors, Causative Organisms, Treatment Strategies, and Visual Acuity Outcomes . Invest. Ophthalmol. Vis. Sci. 2003;44(13):1842.
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Purpose: To investigate the clinical features, potential predisposing factors, causative organisms, treatment strategies, and visual acuity outcomes associated with endogenous endophthalmitis. Methods: The medical records were reviewed of all patients treated for endogenous endophthalmitis at a single institution between January 1, 1996 to December 31, 2001. Results: The study included 22 patients with a median age at presentation of 52.5 years (range, 26 to 82 years) and a median follow-up of 1.4 months (range, 0.1 to 48.9 months). Presenting ocular signs and symptoms included ocular pain (14/22; 63.6%), decreased vision (16/22; 72.7%) and hypopyon (9/22; 40.9%). Potential predisposing factors for endogenous endophthalmitis included diabetes mellitus (7/22; 31.8%), cancer (5/22; 22.7%), organ transplantation (5/22; 22.7%), intravenous line-associated sepsis (3/22; 13.6%), intravenous drug use (1/22; 4.5%), and human immunodeficiency virus (HIV) infection (1/22; 4.5%). The most common isolates identified were Aspergillus species (5/22; 20.8%), Staphylococcus aureus (4/22; 16.7%), and Candida albicans (3/22; 12.5%). Treatment consisted of tap and injection of intraocular antibiotics in 4/22 (18.2%) eyes, vitrectomy and injection of intraocular antibiotics in 14/22 (63.6%), initial tap and injection of intraocular antibiotics followed by vitrectomy and intraocular antibiotics in 2/22 (9.1%), and initial tap and injection of antibiotics followed by evisceration or enucleation in 2/22 (9.1%) eyes. Visual acuity was 5/200 or better in 9/22 (40.9%) eyes on presentation and 12/22 (54.5%) eyes at final follow-up. Two (9.1%) eyes were enucleated and 4/22 (18.2%) eyes were no light perception at final follow-up. Conclusions: Endogenous endophthalmitis is associated with poor visual acuity outcomes and a high risk of evisceration or enucleation. Compared to series of patients with postoperative or post-traumatic endophthalmitis, patients with endogenous endophthalmitis are more likely to have fungal isolates. All patients in the current series had at least one potential predisposing factor for developing endogenous endophthalmitis, including such immunocompromising conditions as diabetes mellitus, cancer, organ transplantation, and HIV.
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