Culture-proven endogenous endophthalmitis: Clinical features and visual acuity outcomes

Vivian Schiedler, Ingrid U. Scott, Harry W Flynn, Janet L Davis, Matthew S. Benz, Darlene Miller

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Abstract

Purpose To investigate clinical features and visual acuity outcomes associated with endogenous endophthalmitis. Design Retrospective, observational case series. Methods Twenty-one eyes of 21 patients treated at Bascom Palmer Eye Institute for culture-proven endogenous endophthalmitis between 1996 and 2002 were reviewed. Results Patients were followed a mean of 3 months (range, 1 to 12 months). Fungal isolates occurred in 13 eyes (62%), gram-positive isolates in 7 (33%), and gram-negative isolates in 1 (5%). Twelve patients (57%) were hospitalized at the time of diagnosis and 6 patients (29%) died within 2 months of diagnosis. Initial treatment included tap and injection of intravitreal medication in 10 eyes (48%) and pars plana vitrectomy with injection of intravitreal medication in 11 eyes (52%). Final visual outcomes were obtainable for 18 eyes (two patients died within 10 days of diagnosis, and one patient was lost to follow-up). Eight (44%) of these 18 eyes achieved a visual acuity of 20/400 or better and 10 (56%) of 18 eyes achieved a visual acuity worse than 20/400, including 3 that were either enucleated or eviscerated. Three eyes with Aspergillus endophthalmitis had worse visual outcomes than eyes with either Candida (P = .036) or bacterial endophthalmitis (P = .024). Conclusions Compared with published series of postoperative or post-traumatic endophthalmitis, patients with endogenous endophthalmitis are more likely to have fungal isolates with a predominance of Candida albicans. Endogenous endophthalmitis is generally associated with high mortality and poor visual acuity outcomes, particularly when caused by more virulent species such as Aspergillus.

Original languageEnglish
Pages (from-to)725-731
Number of pages7
JournalAmerican Journal of Ophthalmology
Volume137
Issue number4
DOIs
StatePublished - Apr 1 2004

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Endophthalmitis
Visual Acuity
Intravitreal Injections
Aspergillus
Temazepam
Lost to Follow-Up
Vitrectomy
Candida albicans
Candida

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Culture-proven endogenous endophthalmitis : Clinical features and visual acuity outcomes. / Schiedler, Vivian; Scott, Ingrid U.; Flynn, Harry W; Davis, Janet L; Benz, Matthew S.; Miller, Darlene.

In: American Journal of Ophthalmology, Vol. 137, No. 4, 01.04.2004, p. 725-731.

Research output: Contribution to journalArticle

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abstract = "Purpose To investigate clinical features and visual acuity outcomes associated with endogenous endophthalmitis. Design Retrospective, observational case series. Methods Twenty-one eyes of 21 patients treated at Bascom Palmer Eye Institute for culture-proven endogenous endophthalmitis between 1996 and 2002 were reviewed. Results Patients were followed a mean of 3 months (range, 1 to 12 months). Fungal isolates occurred in 13 eyes (62{\%}), gram-positive isolates in 7 (33{\%}), and gram-negative isolates in 1 (5{\%}). Twelve patients (57{\%}) were hospitalized at the time of diagnosis and 6 patients (29{\%}) died within 2 months of diagnosis. Initial treatment included tap and injection of intravitreal medication in 10 eyes (48{\%}) and pars plana vitrectomy with injection of intravitreal medication in 11 eyes (52{\%}). Final visual outcomes were obtainable for 18 eyes (two patients died within 10 days of diagnosis, and one patient was lost to follow-up). Eight (44{\%}) of these 18 eyes achieved a visual acuity of 20/400 or better and 10 (56{\%}) of 18 eyes achieved a visual acuity worse than 20/400, including 3 that were either enucleated or eviscerated. Three eyes with Aspergillus endophthalmitis had worse visual outcomes than eyes with either Candida (P = .036) or bacterial endophthalmitis (P = .024). Conclusions Compared with published series of postoperative or post-traumatic endophthalmitis, patients with endogenous endophthalmitis are more likely to have fungal isolates with a predominance of Candida albicans. Endogenous endophthalmitis is generally associated with high mortality and poor visual acuity outcomes, particularly when caused by more virulent species such as Aspergillus.",
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