The Clinical Spectrum of Endophthalmitis: Incidence, Predisposing Factors, and Features Influencing Outcome

Abstract

Endophthalmitis is a virulent ocular inflammation typically developing suddenly and progressing rapidly. To better understand the incidence and factors predisposing to infection and influencing outcome, records of 114 patients with endophthalmitis hospitalized at one institution from 1980 to 1986 were reviewed. An infectious origin was confirmed in 79 patients (69%). The most common pathogens included staphylococcal species (Staphylococcus epidermidis, 33 cases; Staphylococcus aureus, 8 cases), streptococci (18 cases), gram-negative organisms (10 cases), and fungi (7 cases). Predisposing factors for infective endophthalmitis included preceding ocular surgery (67%), penetrating trauma (13%), systemic infection (11%), and periocular infection (5%). Despite vitrectomies and aggressive use of antibiotics, 42 patients (53%) with infective endophthalmitis suffered major visual loss. Morbidity was less pronounced with infection caused by S. epidermidis (23%; P less than .05). Patients with infective endophthalmitis more likely required repeated vitrectomies, were hospitalized longer, and had a worse outcome (as measured by complete enucleation) than those with "sterile" endophthalmitis. On the basis of these data, empiric vancomycingentamicin might be initiated in patients with endophthalmitis. Studies to define optimal management are needed, because the morbidity associated with this entity remains pessimistically high despite state-of-the-art treatment.

Climatic influence on conjunctival bacteria of patients undergoing cataract surgery

“…1 Also in the same period, in Scotland, 2 a hospital infection control team reported more acute PE than expected after cataract surgery, according to the normal incidence. 3 Among the many risk factors involved in the PE pathogenesis, [4][5][6][7][8][9][10][11] it is difficult to assess the weight of climatic influence; however, as conjunctival bacteria are the main source of contamination in cataract surgery, 12,13 it is quite logical to expect that the prevalence of conjunctival bacteria determines the prevalence of the infectious PE. Today, the world-wide use of povidona iodine solution as a preoperative prophylaxis in cataract extraction 14 could provide homogeneity in the kind of bacteria that produce PE all over the world, which was impossible to detect when a great number of different prophylactic techniques were used.…”

Metastatic choroidal abscess and choroidal neovascularization in a patient with Staphylococcus aureus renal abscess

“…1 The underlying medical conditions of susceptible hosts include diabetes mellitus, intravenous drug abuse, cardiac valvular abnormality, 2 malignancy, and immune-compromised patients. Mowat et al 3 suggested the defect in the chemotaxis function of leukocytes in poorly controlled diabetic patients, as this case, probably makes such patients more susceptible to bacterial infection.…”

“…Sir, Metastatic choroidal melanoma to the ipsilateral orbit 7 years after enucleation Metastasis of choroidal melanoma to the contralateral orbit is rare. 1 Only one case with bilateral orbital involvement has been previously reported. 2 To our knowledge, we present the first case of choroidal melanoma metastasis to the ipsilateral orbit, 7 years after enucleation.…”

“…1 Nine cases of metastasis of a choroidal melanoma to the contralateral orbit after enucleation have been reported. 1 Massy et al 2 described an 81-year-old man who developed multiple orbital metastases bilaterally 8 years after enucleation.…”

An in vitro study on the compatibility and concentrations of combinations of vancomycin, amikacin, and dexamethasone in human vitreous

“…1 Owing to its urgent nature, empirical combination of antibiotics with coverage against both Grampositive and Gram-negative organisms are commonly employed. 2,3 Frequently used regimens include combination of vancomycin and aminoglycosides, or vancomycin with ceftazidime.…”