Two Cases of Endogenous Endophthalmitis Caused by Gram-Positive Bacteria with Good Visual Outcome

Abstract

Background: Endogenous endophthalmitis is a rare disease and its visual prognosis is poor. Case Reports: We present two patients, a 60-year-old man and a 53-year-old man, who developed endogenous endophthalmitis caused byGram-positive organismsbut recovered good vision after antibiotics and vitrectomy. Results: The first patient complained of ocular pain and visual decrease in his right eye. Ophthalmoscopy showed inflammation in the anterior chamber and vitreous opacities. Antibiotic was administrated systemically, and blood culture detected Streptococcus anginosus. He underwent successful heart surgery for endocarditis and total dental extraction for severe gingivitis. Vitrectomy was performed 36 days after the onset and vision improved from 0.02 to 0.7. The second patient was referred for acute visual decrease in his left eye. Severe iritis and vitreous opacities were observed, and systemic examination showed acute pyelitis and prostatic abscesses. Blood cultures detected Staphylococcus sp., and systemic antibiotics were given. Vitrectomy was performed 12 days after the onset, and vision improved from 0.06 to 1.2. Conclusions: We conclude that the rapid treatment with systemic antibiotics for the organisms at the primary site, and the vitrectomy, even though delayed, can lead to a good recovery of vision.

Endogenous Endophthalmitis in the Korean Population

“…Yoon et al 20 reported that the retina remained attached in all cases, and CF or better visual acuity was attained in half of the cases after early vitrectomy for endogenous endophthalmitis. Itoh et al 26 reported good visual outcome despite delayed surgical treatment. In our study, vitrectomy was done in 23 cases (43.1%) and visual acuity more than CFs was seen in 11 cases in the vitrectomy group.…”

Clinical features and prognostic factors of Klebsiella endophthalmitis—10-year experience in an endemic region

“…There are studies in favor of early vitrectomy. [21][22][23][24] However, the benefit could not be replicated in other studies. 1,25 In this regard, we advocate early vitrectomy for patients with poor visual prognostic indicators especially the presence of hypopyon, which is independently associated with a higher rate of evisceration in this study.…”

Endogenous endophthalmitis: diagnosis, management, and prognosis

“…This is well above the percentage of patients reported with similar improvement before this study [ 11 ]. Itoh et al also reported that early aggressive treatment can lead to good visual outcomes [ 89 ]. Early vitrectomy within 2 weeks of presentation, especially in severe cases or when suspecting a highly virulent organism, can lead to a good overall outcome [ 79 , 82 , 83 , 86 , 90 ].…”