July 2019
Volume 60, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2019
Gram-negative endophthalmitis; microbiology, clinical associations and visual outcomes in Victoria, Australia
Author Affiliations & Notes
  • Louis Stevenson
    Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
  • Rosie C.H Dawkins
    Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
    Centre for Eye Research Australia, Melbourne, Victoria, Australia
  • Harshvardha Sheorey
    Department of Pathology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
  • Andrew Hurley
    Centre for Eye Research Australia, Melbourne, Victoria, Australia
  • Penelope J Allen
    Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
    Centre for Eye Research Australia, Melbourne, Victoria, Australia
  • Footnotes
    Commercial Relationships   Louis Stevenson, None; Rosie Dawkins, None; Harshvardha Sheorey, None; Andrew Hurley, None; Penelope Allen, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science July 2019, Vol.60, 846. doi:
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      Louis Stevenson, Rosie C.H Dawkins, Harshvardha Sheorey, Andrew Hurley, Penelope J Allen; Gram-negative endophthalmitis; microbiology, clinical associations and visual outcomes in Victoria, Australia. Invest. Ophthalmol. Vis. Sci. 2019;60(9):846.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : To describe the microbiology profile, clinical associations including precipitating events, and visual outcomes in patients presenting with gram-negative endophthalmitis.

Methods : Data were collected prospectively on all patients presenting with endophthalmitis to the Royal Victorian Eye and Ear Hospital, East Melbourne, Australia, between July 1997 and June 2017. Inclusion criteria were; a clinical diagnosis of endophthalmitis and identification of gram-negative organisms on microscopy or microbial culture. Accepted microscopy and culture specimens included vitreous and anterior chamber biopsies, evisceration or enucleation contents, retinal biopsies and corneal scrapings, if it was deemed that endophthalmitis occurred secondary to microbial keratitis.

Results : Ninety-seven eyes from 95 patients were included. There were 58 (61.1%) males and the mean age was 73.4 years (SD = 15.6). One-hundred gram-negative organisms were isolated in 9.3% of eyes with endophthalmitis over the study period. Fourteen (14.4%) eyes had polymicrobial infections. The most common organisms were Pseudomonas aeruginosa (34.0%, n = 34), Haemophilus influenzae (17.0%, n = 17), Moraxella spp. (16.0%, n = 16), and Klebsiella pneumoniae (9.0%, n = 9).

Microbial keratitis was the most common precipitating event (26.8%, n = 26) followed by glaucoma surgery (24.7%, n = 24), cataract surgery (22.7%, n = 22) and endogenous infection (15.5%, n = 15). At presentation, the fundus was not visible in 81 (83.5%) eyes and 13 (13.7%) patients had a relative afferent pupillary defect. Visual acuity was count fingers or worse in 83 (85.6%) and 64 (66.0%) eyes at presentation and follow-up, respectively. Twenty-nine (29.9%) eyes were eviscerated or enucleated.

Conclusions : Gram-negative bacteria represent a clinically significant group of causative organisms in endophthalmitis. Seventy-six percent of cases were caused by either; Pseudomonas aeruginosa, Haemophilus influenzae, Moraxella spp., and Klebsiella pneumoniae. Microbial keratitis was the most common precipitating event, confirming its significance as a risk factor for the development of endophthalmitis. Gram-negative endophthalmitis is associated with poor presenting visual acuity and is similarly is associated with very poor visual outcomes, with almost 30% of affected eyes being eviscerated or enucleated.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.

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