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Michelle Abou-Jaoude, Garrett Oberst, laura Coyne, Alexander Cherry, Daniel Moore, Claire Fraser; Fundus Findings in Endocarditis: results of a new screening protocol for endogenous endophthalmitis. Invest. Ophthalmol. Vis. Sci. 2019;60(9):2030.
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© ARVO (1962-2015); The Authors (2016-present)
To determine the utility of an ocular screening protocol evaluating for significant retinal findings such as endophthalmitis or subretinal abscess in the setting of endocarditis, to characterize the epidemiology of fundus findings in endocarditis, and to determine if certain patient factors are associated with an increased incidence of significant ocular pathology.
Retrospective review of all patients admitted to a single academic center with a diagnosis of acute endocarditis at discharge after implementation of a retinal screening protocol during a 6 month time period. Inpatient providers were instructed to call for fundus examination for all patients with new endocarditis. Data collected included age at admission, gender, intravenous drug use (IVDU) status, culture and echo results, and if screened, visual acuity, symptoms, presence of retinal findings, specific findings of Roth spots, subretinal abscess, and endophthalmitis requiring tap and inject.
503 patients were identified using ICD codes as having a diagnosis of endocarditis at discharge. Of these, ophthalmology was consulted on 134 patients, 111 of whom met Duke criteria for definite endocarditis and received dilated fundus examinations. Of these, 26 (23.4%) had retinal findings defined as at least one hemorrhage or cotton wool spot, 8 (7.2%) had Roth spots, 9 (8.1%) had subretinal abscess, of which 5 required tap and inject. Of patients with subretinal abscess or requiring tap and inject, 6 reported visual changes, and 3 were unable to report symptoms secondary to mental status (i.e. intubation). No awake and asymptomatic patients had endophthalmitis requiring treatment. Of the factors analyzed (age, gender, IVDU status, culture and echo results, and symptoms) only symptomatology and age were correlated with retinal findings (p=0.009, p=0.025), and only symptomatology was correlated with finding subretinal abscess (p=<0.001).
A high incidence of subretinal abscess and endophthalmitis requiring tap and inject was found in association with acute endocarditis. These cases may be detected with a proposed screening protocol consisting of a dilated fundus exam for all patients with a new diagnosis of endocarditis who cannot competently deny visual symptoms. Conversely, no endocarditis patients who could deny visual changes had retinal findings leading to a change in management of their disease course.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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