Severe bacterial endophthalmitis: towards improving clinical outcomes

Abstract

Endophthalmitis is an infection and inflammation of the interior of the eye that can result in significant vision loss. This infection occurs as a result of the seeding of organisms into the interior of the eye following surgery (postoperative), trauma (post-traumatic) or an infection in another site in the body (endogenous). The general rate of endophthalmitis has remained steady over the past several years. However, the increased use of intraocular injections to treat various degenerative and inflammatory ocular diseases, in addition to the already large and growing number of invasive ocular surgeries, may increase the opportunities in which organisms can gain access to the eye. In most cases of endophthalmitis, useful vision can be retained if proper treatment is instituted. However, in severe cases of bacterial endophthalmitis, blindness often occurs despite treatment. This article summarizes information on endophthalmitis epidemiology, treatment issues and current regimens, and recent experimental and clinical efforts to improve the outcome of severe and blinding forms of bacterial endophthalmitis.

Ocular Complications of Endocarditis

“…(30,31) The course of endophthalmitis, treatment effectiveness and visual outcome can be unpredictable. (33) Clinical presentation of the disease depends, in part, on the relative virulence of the infecting pathogen, the mechanism of introduction into the eye and how quickly treatment is initiated. (33) Other factors that affect the outcome of infection include the patients' age, how vulnerable the infecting agent is to antibiotic therapy and the anatomic condition of the eye during infection.…”

“…(33) Clinical presentation of the disease depends, in part, on the relative virulence of the infecting pathogen, the mechanism of introduction into the eye and how quickly treatment is initiated. (33) Other factors that affect the outcome of infection include the patients' age, how vulnerable the infecting agent is to antibiotic therapy and the anatomic condition of the eye during infection. (33) Clinical studies have reported that increased time between infection and treatment is associated with a worse visual outcome.…”

“…(33) Other factors that affect the outcome of infection include the patients' age, how vulnerable the infecting agent is to antibiotic therapy and the anatomic condition of the eye during infection. (33) Clinical studies have reported that increased time between infection and treatment is associated with a worse visual outcome. (19,34) Endophthalmitis may be as subtle as white nodules on the lens capsule, iris, retina, or choroid.…”

“…(33,34) Patients may require enucleation to eradicate a blind and painful eye. (38) Mortality is related to the patient's comorbidities and the underlying medical problem, especially when considering the etiology of hematogenous spread in endogenous infections.…”

“…(52,53) The most common cause in two-thirds of the infections is Gram-positive bacteria. (31,33) Although the most common agent was S.aureus (25% of patients), the most common group was streptococcus (32%). (31,33) Endogenous endophthalmitis in adults caused by group B Streptococcus has been reported rarely and is almost exclusively related to infective endocarditis.…”