Endogenous endophthalmitis: 10-year experience at a tertiary referral centre

Abstract

Purpose Endogenous endophthalmitis (EE) is a sight-threatening emergency and the aetiology is often multifactorial. Delayed diagnosis may exacerbate the poor visual prognosis. We describe the management and visual outcomes of EE presenting to a tertiary referral centre. Patients and methods A prospective consecutive case series of 64 patients presenting with presumed EE from 1997 to 2007 to the Royal Victorian Eye and Ear Hospital were included. All data were collected in a standardized manner. Outcome measures included: visual acuity, microbial profiles, and vitrectomy rate. Results In total, 64 cases of EE were identified over the study period with a mean age of 57.5 years, and 53.5% were male. Presenting acuities ranged from Snellen 6/6 to no perception of light (NPL). Identifiable risk factors were present in 78.1%, with the majority related to intravenous drug abuse. A 64.1% culture positivity rate was recorded. A vitrectomy rate of 57, 56, and 21% was recorded in documented bacterial, fungal, and no growth cases, respectively. Final Snellen acuities ranged from 6/6 to NPL. A total of 5 out of 64 eyes were enucleated, of which 3 identified Klebsiella species. Better visual outcome was documented in fungal cases. Conclusion EE is a serious ocular condition and has a varied aetiology. Visual outcomes are often poor, irrespective of the method of management. Fungal aetiology often confers a better prognosis, and vitrectomy is advocated for bacterial proven cases.

Endoftalmitis endógenas: revisión de una serie de casos y revaloración de una entidad ocular grave

“…el agente aislado en aproximadamente 35% de todos los casos 10 . Dentro de las especies bacterianas destacan Staphylococcus aureus, Streptococcus spp, Neisseria meningitidis, enterobacterias (con predominio en el este asiático) 4,6 y Pseudomonas aeruginosa, que está emergiendo entre los pacientes más graves 16 .…”

“…En pacientes inmunodeprimidos o UDVP se aíslan Candida spp. 10 , Aspergillus spp con elevada mortalidad 17 y otros hongos filamentosos 18 , Listeria monocytogenes 19 o Bacillus cereus, principalmente en UDVP por contaminación de la solución utilizada para inyectarse la droga 1 .…”

“…Se incluyeron en el estudio los pacientes con diagnós-tico clínico de endoftalmitis endógena, definido como la presencia de células en la cámara anterior (Tyndall positivo) 9 . Dependiendo de la gravedad de la infección pueden aparecer, además, los siguientes signos: fibrina en la cámara anterior y/o hipopion y/o vitritis aguda o focos vítreos o retino-coroideos 9,10 . Se excluyeron aquellos pacientes con historia previa de cirugía intraocular, traumatismo ocular, antecedente de ampolla de filtración o úlcera corneal el año anterior al diagnóstico de la infección.…”

Bilateral endogenous ophthalmitis due to Candida glabrata after complicated bariatric surgery

“…1 One or more risk factors are often involved in the development of this condition. 2 In the etiology of endogenous fungal endophthalmitis, Candida albicans (C. albicans) is the most common agent.…”

“…2 In the etiology of endogenous fungal endophthalmitis, Candida albicans (C. albicans) is the most common agent. 1 Treatment regimens include various combinations of systemic antifungal or intravitreal injection plus vitrectomy. 3 Although endogenous fungal endophthalmitis has been reported, bilateral ocular involvement is a less common condition.…”