Clinical characteristics and risk factors for visual prognosis according to the types of infectious endophthalmitis

Abstract

Background Endophthalmitis is a fatal ophthalmological emergency that needs prompt diagnosis and treatment. This study aimed to evaluate the clinical characteristics and investigate risk factors for the visual prognosis of the different types of endophthalmitis. Methods This retrospective study included 239 eyes diagnosed with endophthalmitis at the Pusan National University Hospital between January 2006 and December 2020. All patients were classified into six groups based on the etiology of endophthalmitis: post-cataract surgery, post-vitrectomy, post-glaucoma surgery, post-intravitreal injection, endogenous, and post-trauma. Demographics and clinical characteristics such as age, sex, laterality, initial symptoms, the interval between the primary causable event and diagnosis of endophthalmitis, initial and final visual acuity, management, and culture results were reviewed and statistically analyzed. Risk factors for poor visual prognosis were also analyzed according to the type of endophthalmitis. Results Of the 239 cases of endophthalmitis, the most common cause was post-cataract surgery, that occurs within two weeks post-surgery. Gram-positive Staphylococcus was cultured most frequently. Fusarium was characteristically cultured from delayed post-cataract surgery endophthalmitis (14 days–6 weeks post-surgery). Post-vitrectomy endophthalmitis occurred within 3.3 days post-surgery, but post-glaucoma surgery endophthalmitis developed a long period after surgery, averaging 2,742 days. Post-intravitreal injection endophthalmitis occurred most frequently following bevacizumab injection, and Staphylococcus was most commonly isolated. For endogenous endophthalmitis, the pyogenic liver abscess was the most common underlying disease, and Klebsiella was isolated most frequently. Post-traumatic endophthalmitis mostly occurred in young men. Advanced age and poor initial visual acuity were risk factors for poor visual prognosis (P = 0.041, odds ratio = 1.024 and P < 0.001, odds ratio = 3.904, respectively, using logistic regression analysis). Conclusion Advanced age and initial visual acuity were risk factors for poor visual prognosis in cases of endophthalmitis caused by various etiologies. Early diagnosis and treatment of endophthalmitis are required, especially in older patients.

Endophthalmitis After Intravitreal Bevacizumab (Avastin) Injections: An Outbreak Investigated

“…The occurrence of endophthalmitis depends on the patient's immune status and the virulence/dose of the organisms. As far as the organisms responsible for endophthalmitis are concerned, one study found that Staphylococcus was the most commonly isolated organism [10]. In another study, it was found that Streptococcus viridans frequently cause aggressive but sometimes delayed endophthalmitis after IVT injections [11].…”

Endophthalmitis After Vitreoretinal Surgery

“…Bu farklı sonuçlara kapakların ve konjonktivanın sterilizasyonu, korneadaki kesilerinin yeri, boyutu, stabilitesi, hastanın immun durumu ve cerrahide kullanılan tampon maddelerin özellikleri gibi diğer faktörlerin etkili olduğu düşünülmektedir. 22,24 İntravitreal Tamponlar:…”

“…Sıvı tamponatlar, hava, gaz ve silikon yağına göre daha az yüzey gerilimine sahip oldukları için postoperatif erken dönemde sızıntı ve hipotoni riski yüksektir. 3,6,16,[22][23][24][25] Shimada ve ark. 23 gaz yada hava tamponat uyguladığı olguların %9'unda postoperatif hipotoni gözlerken, serum fizyolojik uyguladıkları olgularında hipotoni görülme oranın %20 düzeyine çıktığını bildirmiştir.…”

“…Anterior segment optik koherens tomografi tetkiklerinde hava, gaz ya da silikon uygulanan gözlerde sıvı tamponatlara göre yara yeri iyileşmesinin daha hızlı olduğu bildirilmiştir. 18,22,23,25 Chiang ve ark. 25 6,16,27,34 Endoftalmiye neden olan etkenin saptanmasında Polimeraz Zincir Reaksiyonu (Polymerase Chaine Reaction =PCR ) yöntemi kültüre göre daha üstün olup, kültürde üreme gözlenmeyen örneklerde bile mikroorganizmaları saptayabilmektedir.…”

“…Endoftalmide klinik bulguları genel olarak gözde ağrı, görmede azalma, konjonktivada hiperemi, kemozis, ön kamarada inflamasyon, hipopion, vitreus bulanıklığı, vitritis, vitreusta fibroz eksudasyonlar, vitreus içi membranlar oluşuma, retinada vaskülit, intraretinal hemorajiler, yaygın retinal ödem şeklinde olup etken mikroorganizmanın virülansına ve ürettikleri toksinlerin etki düzeyine göre değişmektedir. 2,4,5,7,15,16,22 Virülansı yüksek olan Basillus sereusa bağlı endoftalmilerde klasik bulgulara ek olarak basilin ürettiği proteaz, lipaz, enterotoksin ve hemolizinin etkisiyle tipik olarak korneada halka tarzında apse, kısa süre içinde retina tabakalarında yaygın ödem, nekroz, yaklaşık 12 saat içinde retina dekolmanı gelişimi, 2 gün içinde total görme kaybı ve hatta gözün total kaybı gözlenir. Basillus sereus da oküler bulgulara ilave olarak ateş, halsizlik gibi sitemik bulgular ve kanda polimorfonükleer lökositozis da saptanır.…”