Characteristics and Outcomes of Endogenous Endophthalmitis: Eight-Year Experience at a Tertiary Care Center.

Abstract

PURPOSE\nTo describe the characteristics and outcomes of endogenous endophthalmitis.\n\n\nDESIGN\nRetrospective case series.\n\n\nPARTICIPANTS\nPatients with endogenous endophthalmitis.\n\n\nMETHODS\nA retrospective chart review of patients diagnosed with endogenous endophthalmitis between September 1, 2006, and November 1,\xa02014.\n\n\nMAIN OUTCOME MEASURES\nClinical findings, treatments, microbial results, visual outcomes, and secondary ocular sequelae.\n\n\nRESULTS\nSixty-three patients (68 eyes) were diagnosed with endogenous endophthalmitis. Ocular symptoms were the first manifestation of disease in 76% of patients. Fungal and bacterial endophthalmitis were seen in 37% (n\xa0= 25) and 43% (n\xa0= 29) of eyes, respectively. In 47% of eyes (n\xa0= 32), the disease was associated with intravenous drug use. Eighteen percent of eyes (n\xa0= 12) underwent an initial pars plana vitrectomy (PPV) with intravitreal antibiotics, none of which required a secondary intervention for acute infection. Four percent of eyes (n\xa0= 3) received only systemic treatment. Seventy-eight percent of eyes (n\xa0= 53) underwent initial bedside aspirate with intravitreal injection of antibiotics (tap-and-injection), of which 55% (n\xa0= 29) required a secondary PPV. Of eyes that underwent secondary PPV after initially negative culture results from the tap-and-injection, 52% demonstrated positive culture results at the time of secondary PPV (n\xa0= 11/21) despite all but 1 having received appropriate antimicrobial coverage initially. Fifty-four percent of eyes (n\xa0= 37) experienced secondary ocular sequelae. Eyes that received initial tap-and-injection had statistically nonsignificant better average initial vision, but worse average vision at each follow-up interval, compared to PPV while being less likely to gain 2 lines or more of vision at every follow-up interval except 6 months, with the difference reaching statistical significance at 1 week (odds ratio = 0.014; P\xa0= 0.037). Eyes that underwent initial tap-and-injection were statistically significantly more likely to require a secondary PPV (55% vs. 0%; P\xa0= 0.0006) and had fewer positive microbial results (19% vs. 67%) than those that underwent initial PPV (P\xa0= 0.002).\n\n\nCONCLUSIONS\nMost eyes that received initial tap-and-injection eventually underwent a secondary PPV. Initial PPV may have an important role in management because it was associated with better diagnostic yield and a trend toward better visual outcomes.