Abstract
Purpose :
To report on the epidemiological, clinical and ophthalmological features of patients diagnosed with endophthalmitis in a tertiary referral center in Jerusalem
Methods :
Retrospective review of medical charts of patients presenting with endophthalmitis over a 15 year period
Results :
Included were 73 eyes of 70 patients. Males were affected in 56% of cases. Mean age at presentation was 60 years. Exogenous endophthalmitis accounted for 78% of cases and endogenous endophthalmitis for 22% of cases. Of the exogenous cases, most followed an intraocular surgery ( 61%), 18% occurred after intravitreal injections, 14% followed infectious keratitis and 7% were post-traumatic. Endogenous cases were predominantly observed in diabetic patients. Bacterial infection was the predominant entity diagnosed in 40 eyes (55%), fungal in 8 eyes (11%) and in the remaining 25 eyes (34%) culture result was non-yielding. Staphylococcus epidermidis was the most commonly isolated microbe in 19% of eyes and Enterococcus faecalis was the second most common detected in 6% of the eyes. Mean logMAR visual acuity (VA) at presentation was 1.6 and it remained unchanged at last follow-up. At presentation, 78% of eyes had poor VA (logMAR ≥1) and this significantly decreased to 57% by the last follow-up. Systemic antimicrobial therapy was administered to 67% of patients. Intravitreal antibiotics were administered to 99% of eyes with ceftazidime and vancomycin being the most commonly given. Intravitreal dexamethasone was administered concomitantly to 30% of eyes. Pars plana vitrectomy was perfomred in 75% of eyes. Enucleation/evisceration was performed in 5 eyes (7%). There was no evidence of bacterial resistance in the antibiograms for either vancomycin or ceftazidime.
Conclusions :
Intraocular surgery remains the most common event preceding endophthalmitis with coagulase-negative staphylococci being the most frequently detected microbes. It is a fulminant infection resulting in poor visual outcome despite prompt treatment. Vancomycin and ceftazidime remain an effective combination showing no changes in susceptibility over the years.
This is a 2020 ARVO Annual Meeting abstract.