Presentation and Outcome of a Cluster of Patients with Endogenous Endophthalmitis: A Case Series

Abstract

Background: The aim of this study was to investigate the clinical features and visual acuity outcomes associated with endogenous endophthalmitis. Material and Methods: Seven eyes of 6 patients treated at Epsom and St Helier University Hospitals between 2010 and 2013 were reviewed for endogenous endophthalmitis. Results: Patients were followed for a mean of 7 months (range 1 to 13). Positive blood cultures were obtained in 5 patients (83 %), including 1 patient with fungal isolates (17 %), two patients with Gram-positive isolates and another two with Gram-negative isolates. Five patients (83 %) were hospitalized at the time of diagnosis and 2 patients (33 %) died within 6 months of diagnosis. Initial treatment included vitreous tap and injection of intravitreal antibiotics. Only in one eye (14 %) were positive results from the biopsy obtained. Four eyes (57 %) achieved a final visual acuity of > 6/60. Patients with a Klebsiella endophthalmitis had worse visual outcome. Conclusions: Endogenous endophthalmitis is generally associated with high mortality and poor visual acuity outcomes. Gram-negative species are associated with poorer visual acuity. Vitreous biopsy has a weak diagnostic relevance as is it often negative.

Zusammenfassung

Hintergrund: Retrospektive Evaluation einer Fallserie von endogenen Endophthalmitiden. Material und Methoden: Analysiert wurden 7 Augen von 6 konsekutiven Patienten, die mit einer endogenen Endophthalmitis zwischen 2010 und 2013 behandelt wurden. Ergebnisse: Die Follow-up Zeit betrug im Durchschnitt 7 Monate. Insgesamt 5 Patienten (83 %) hatten eine positive Blutkultur: bei einem Patient wurde Candida gefunden (17 %), bei je 2 Patienten (33 %) wurden grampositive beziehungsweise gramnegative Erreger isoliert. Zwei Patienten (33 %) starben innerhalb von 6 Monaten nach Diagnosestellung. Bei allen Augen wurde eine Aspirationsbiopsie des Glaskörpers durchgeführt sowie gleichzeitig Antibiotika intravitreal verabreicht. Nur bei einem Auge (14 %) konnte ein positives Resultat gewonnen werden. 4 Augen (57 %) erreichten nach der Behandlung eine Sehschärfe von > 6/60. Patienten mit einer Klebsiellen-Infektion hatten, verglichen mit den übrigen Patienten, einen deutlich schlechteren Visus. Schlussfolgerungen: Endogene Endophthalmitiden sind in der Regel mit hoher Sterblichkeit und schlechtem Endvisus verbunden. Infektionen mit gramnegativen Erregern sind mit einem schlechteren Visus behaftet. Die Nadelaspirationsbiopsie hat einen geringen diagnostischen Wert, da sie häufig negativ ausfällt.

Schlüsselwörter

Endophthalmitis - endogene Endophthalmitis - Uveitis - Klebsiella

Key words

endophthalmitis - endogenous endophthalmitis - uveitis - Klebsiella

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