https://orcid.org/0000-0003-0189-4707
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ABSTRACT
Purpose
Endogenous endophthalmitis is rare and associated with significant morbidity and mortality. The primary objective was to identify causative organisms. Secondary objectives included the determination of systemic risk factors and visual prognostic factors.
Design
Retrospective review
Methods
78 eyes from 62 subjects over a 21-year period from 1999 to 2020 in Auckland, New Zealand. Parameters assessed included pathologic microbial organism, clinical presentation, treatment, complications, prognostic factors, and visual outcomes.
Methods
Information was collected on microbiology, treatment, visual outcomes, and complications.
Results
Median age was 61.6 years and 32 subjects (51.6%) were male. Diabetes was the most common risk factor seen in 24 (38.7%) subjects. 17 subjects (27.4%) presented directly to ophthalmology and 17.4% had an initial misdiagnosis. 49 subjects (79.0%) presented with reduced vision and only 27 (43.5%) presented with pain. Hypopyon was present in 13 eyes (16.7%). Gram-positive bacteria were the most common causative organism seen in 40 (51.3%) eyes, followed by yeast and fungi in 21 (26.9%) eyes, then gram-negative bacteria seen in 17 (21.8%) eyes. Median final BCVA was 6/18. Severe vision loss occurred in 33 (42.3%) eyes and 7 (9.0%) eyes required evisceration or enucleation. Presenting visual acuity was a significant predictor of visual outcome.
Conclusion
Endogenous endophthalmitis occurred at 1.9 cases per million per year. Ophthalmologists require a high index of suspicion for underlying systemic infection in any subject presenting with ocular inflammation, and need to be aware that endogenous endophthalmitis may present without pain and frequently without hypopyon.
Acknowledgments
Dr Andrew Fox-Lewis, Clinical Microbiology Registrar at LabPLUS Auckland District Health Board for assistance with microbiology detection details for the methods section of this manuscript.
Declaration of interest
The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.