July 2019
Volume 60, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2019
Epidemiology, clinical features and outcomes of bacterial and fungal endogenous endophthalmitis at a tertiary care hospital
Author Affiliations & Notes
  • Sohani Amarasekera
    Ophthalmology, UPMC, Pittsburgh, Pennsylvania, United States
  • Mallika Doss
    Ophthalmology, UPMC, Pittsburgh, Pennsylvania, United States
  • Touka Banaee
    Ophthalmology, UPMC, Pittsburgh, Pennsylvania, United States
  • Regis P Kowalski
    Ophthalmology, UPMC, Pittsburgh, Pennsylvania, United States
  • Andrew W Eller
    Ophthalmology, UPMC, Pittsburgh, Pennsylvania, United States
  • Footnotes
    Commercial Relationships   Sohani Amarasekera, None; Mallika Doss, None; Touka Banaee, None; Regis Kowalski, None; Andrew Eller, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science July 2019, Vol.60, 2024. doi:https://doi.org/
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      Sohani Amarasekera, Mallika Doss, Touka Banaee, Regis P Kowalski, Andrew W Eller; Epidemiology, clinical features and outcomes of bacterial and fungal endogenous endophthalmitis at a tertiary care hospital. Invest. Ophthalmol. Vis. Sci. 2019;60(9):2024. doi: https://doi.org/.

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

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Abstract

Purpose : Sepsis is a significant cause of mortality and morbidity, which may be complicated by endogenous endophthalmitis (EE), a potentially vision threatening infection. Pending blood culture results, empiric therapy is guided by patient history and clinical clues, though this may lead to faulty conclusions. We performed a retrospective chart review to elucidate features of EE while studying differences in the clinical presentation and outcomes between bacterial and fungal causes of EE.

Methods : Medical records of all patients diagnosed with EE at the University of Pittsburgh from September 2015 to September 2018 were reviewed. Exclusion criteria included history of ocular trauma, intra-ocular surgery or intra-ocular injection within 6 months prior to presentation, or a primary external ocular infection. Data collected included demographics, past medical and ocular history, clinical examination, culture data, therapeutic interventions, final corrected visual acuity and mortality. All ophthalmic samples were analyzed by the Campbell Ophthalmic Microbiology Laboratory. Statistics were performed using SPSS.

Results : Thirty-four eyes of twenty-four patients were diagnosed with EE during a three-year period at our institution. Thirteen patients (54%) were male and 11 (46%) were female. Average age at diagnosis was 50.3 years (range 19 to 86 years). All patients were immunocompromised. There were no statistically significant differences in presenting visual acuity, subjective symptom report, or objective measures of intra-ocular inflammation between bacterial and fungal causes (p>0.05). Overall, EE presented as an indolent process that was misdiagnosed in 24% of cases. Complications including final vision < 20/200, retinal detachment, enucleation or death within six months of diagnosis were equivalent between bacterial and fungal cases.

Conclusions : The presentation of EE is remarkably different from that of exogenous endophthalmitis. Without a high index of suspicion and an understanding of the patient’s overall health, the indolent presentation of EE may lead clinicians to misdiagnose this vision threatening condition. However, no clinical feature reliably differentiated between bacterial and fungal sources, highlighting the need to obtain serum and intra-ocular cultures. With early, targeted intervention, favorable clinical outcomes were similar between bacterial and fungal EE.

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

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