Characteristics and Outcomes of Endogenous Endophthalmitis: Eight-Year Experience at a Tertiary Care Center.

Abstract

PURPOSE:

To describe the characteristics and outcomes of endogenous endophthalmitis.

DESIGN:

Retrospective case series.

PARTICIPANTS:

Patients with endogenous endophthalmitis.

METHODS:

A retrospective chart review of patients diagnosed with endogenous endophthalmitis between September 1, 2006, and November 1, 2014.

MAIN OUTCOME MEASURES:

Clinical findings, treatments, microbial results, visual outcomes, and secondary ocular sequelae.

RESULTS:

Sixty-three patients (68 eyes) were diagnosed with endogenous endophthalmitis. Ocular symptoms were the first manifestation of disease in 76% of patients. Fungal and bacterial endophthalmitis were seen in 37% (n = 25) and 43% (n = 29) of eyes, respectively. In 47% of eyes (n = 32), the disease was associated with intravenous drug use. Eighteen percent of eyes (n = 12) underwent an initial pars plana vitrectomy (PPV) with intravitreal antibiotics, none of which required a secondary intervention for acute infection. Four percent of eyes (n = 3) received only systemic treatment. Seventy-eight percent of eyes (n = 53) underwent initial bedside aspirate with intravitreal injection of antibiotics (tap-and-injection), of which 55% (n = 29) required a secondary PPV. Of eyes that underwent secondary PPV after initially negative culture results from the tap-and-injection, 52% demonstrated positive culture results at the time of secondary PPV (n = 11/21) despite all but 1 having received appropriate antimicrobial coverage initially. Fifty-four percent of eyes (n = 37) experienced secondary ocular sequelae. Eyes that received initial tap-and-injection had statistically nonsignificant better average initial vision, but worse average vision at each follow-up interval, compared to PPV while being less likely to gain 2 lines or more of vision at every follow-up interval except 6 months, with the difference reaching statistical significance at 1 week (odds ratio = 0.014; P = 0.037). Eyes that underwent initial tap-and-injection were statistically significantly more likely to require a secondary PPV (55% vs. 0%; P = 0.0006) and had fewer positive microbial results (19% vs. 67%) than those that underwent initial PPV (P = 0.002).

CONCLUSIONS:

Most eyes that received initial tap-and-injection eventually underwent a secondary PPV. Initial PPV may have an important role in management because it was associated with better diagnostic yield and a trend toward better visual outcomes.

• Authors: Bobeck S Modjtahedi, Avni P Finn, Scott M Barb, Matthew J MacLachlan, Tavé van Zyl, Thanos D Papakostas, Dean Eliott
• Journal: Ophthalmology. Retina (Ophthalmol Retina) Vol. 3 Issue 1 Pg. 61-72 (01 2019) ISSN: 2468-6530 [Electronic] United States
• PMID: 30929817 (Publication Type: Journal Article)
• Copyright: Copyright © 2018. Published by Elsevier Inc.

Chemical References

• Anti-Bacterial Agents

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Anti-Bacterial Agents (administration & dosage)
• Bacteria (isolation & purification)
• Endophthalmitis (diagnosis, microbiology, therapy)
• Eye Infections, Bacterial (diagnosis, microbiology, therapy)
• Eye Infections, Fungal (diagnosis, microbiology, therapy)
• Female
• Follow-Up Studies
• Fungi (isolation & purification)
• Humans
• Intravitreal Injections
• Male
• Middle Aged
• Retrospective Studies
• Tertiary Care Centers (statistics & numerical data)
• Time Factors
• Treatment Outcome
• Visual Acuity
• Vitrectomy (methods)
• Vitreous Body (diagnostic imaging, microbiology)
• Young Adult