Abstract
Purpose :
This study aims to compare clinical courses and outcomes of fungal and bacterial endogenous endophthalmitis.
Methods :
Retrospective consecutive chart review of 38 eyes of 32 patients with endogenous endophthalmitis from one county hospital and one academic/private hospital in Dallas, TX, from 2016-2021. Information collected included patient demographic data, presenting symptoms, treatments, and outcomes. Outcome measures included visual acuity, enucleations, and complications, including glaucoma, retinal detachments, and cataracts. T-tests were used to determine significant differences in best corrected visual acuity (BCVA). BCVA was converted to logMAR for analysis.
Results :
Twenty-two eyes had bacterial endophthalmitis, seven had fungal endophthalmitis, and nine infections could not be classified. The most common organisms were Staph Aureus, Candida Albicans, and Pseudomonas Aeruginosa. The most common presenting symptoms were decreased vision (71%), eye redness (42%), and eye pain (39%). Only bacterial infections presented with eye discharge. Bacterial cases presented earlier after symptom onset (an average of 7.8 days) than fungal cases (an average of 46.7 days; p=0.005). On average, bacterial cases presented with a logMar of 2.2, while fungal cases presented with a logMar of 1.3 (p=0.031). Pars plana vitrectomy was performed for eight total endophthalmitis cases (21%), four of which were fungal (57% of fungal cases) and three of which were bacterial (14% of bacterial cases; p=0.019). Fungal infections demonstrated better BCVA one month post-diagnosis (0.84 vs. 2.41; p=0.0009), three months post-diagnosis (0.9 vs. 2.25, p=0.03), six months post-diagnosis (0.93 vs. 2.76, p=0.0008), and at most recent follow-up (0.76 vs. 2.42; p=0.0009) than bacterial infections. Seven patients with bacterial endophthalmitis required enucleation, two developed glaucoma, two developed retinal detachments, and four developed cataracts. None of the fungal infections required enucleation. One patient developed glaucoma, which was the only complication resulting from a fungal case.
Conclusions :
Our findings suggest that bacterial endogenous endophthalmitis may yield a worse visual prognosis than fungal endogenous endophthalmitis and may cause more disease complications. These findings were demonstrated despite a longer delay in treatment for fungal cases, suggesting fungal infections may follow a more indolent course.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.