A M Buettner1, E Berger, R F Guthoff. 1. Augenklinik und Poliklinik, Universitätsklinikum Rostock, Doberaner Str. 140, 18055, Rostock, Germany. armin.buettner@med.uni-rostock.de
Abstract
BACKGROUND: In the rare condition of endogenous (or metastatic) endophthalmitis, septicemia leads to intraocular colonization by bacteria, fungi or parasites. Immunologically compromised or multimorbid patients are commonly affected by this ophthalmological emergency. Although appropriate anti-infective drugs and modern surgical treatment are available, this disease still has a poor prognosis in terms of organ and function preservation. PATIENTS AND METHODS: Between March 2003 and September 2005 nine patients (5 male, 4 female, average age: 60.6 years) with a diagnosis of endogenous endophthalmitis were treated in the Ophthalmology Department of Rostock University Hospital. The infection was in a very advanced stage in eight cases. Six patients offered no fundus view, and in three cases the intraocular view was heavily blurred. Eight patients had an initial visual acuity of <or=20/200, six had visual acuity<or='counting fingers' at the time of first presentation and three patients had no light perception. RESULTS: Primary enucleation was required in two cases. Seven patients were treated with a pars plana vitrectomy, membrane peeling and endotamponade. Six patients developed complications, necessitating a repeat intervention. Microbiological organism identification from a vitreal tap was successful in three cases. A fourth agent isolated (Pyrenophora tritici) is of no pathogenic importance in humans. In the vitrectomy group stabilization of visual acuity was achieved in three cases, and distinctly improved final visual acuity compared to baseline was achieved in four cases. CONCLUSION: Identification of endogenous endophthalmitis at an early stage with immediate initiation of therapy has significant implications for the further course of the disease. If--as in the present study--advanced cases are present with complicating internal or surgical disease and no possibility of short-term follow-up, pars plana vitrectomy should be given priority over single intravitreal injections. Major comparative investigations are desirable regarding the most appropriate method of endotamponade. Highlighting this clinical pattern more widely in non-ophthalmological specialties (e.g. intensive care, surgery) might decrease the rate of adverse outcomes associated with this disease.
BACKGROUND: In the rare condition of endogenous (or metastatic) endophthalmitis, septicemia leads to intraocular colonization by bacteria, fungi or parasites. Immunologically compromised or multimorbid patients are commonly affected by this ophthalmological emergency. Although appropriate anti-infective drugs and modern surgical treatment are available, this disease still has a poor prognosis in terms of organ and function preservation. PATIENTS AND METHODS: Between March 2003 and September 2005 nine patients (5 male, 4 female, average age: 60.6 years) with a diagnosis of endogenous endophthalmitis were treated in the Ophthalmology Department of Rostock University Hospital. The infection was in a very advanced stage in eight cases. Six patients offered no fundus view, and in three cases the intraocular view was heavily blurred. Eight patients had an initial visual acuity of <or=20/200, six had visual acuity<or='counting fingers' at the time of first presentation and three patients had no light perception. RESULTS: Primary enucleation was required in two cases. Seven patients were treated with a pars plana vitrectomy, membrane peeling and endotamponade. Six patients developed complications, necessitating a repeat intervention. Microbiological organism identification from a vitreal tap was successful in three cases. A fourth agent isolated (Pyrenophora tritici) is of no pathogenic importance in humans. In the vitrectomy group stabilization of visual acuity was achieved in three cases, and distinctly improved final visual acuity compared to baseline was achieved in four cases. CONCLUSION: Identification of endogenous endophthalmitis at an early stage with immediate initiation of therapy has significant implications for the further course of the disease. If--as in the present study--advanced cases are present with complicating internal or surgical disease and no possibility of short-term follow-up, pars plana vitrectomy should be given priority over single intravitreal injections. Major comparative investigations are desirable regarding the most appropriate method of endotamponade. Highlighting this clinical pattern more widely in non-ophthalmological specialties (e.g. intensive care, surgery) might decrease the rate of adverse outcomes associated with this disease.