Bobeck S Modjtahedi1, Avni P Finn2, Scott M Barb2, Matthew J MacLachlan3, Tavé van Zyl2, Thanos D Papakostas4, Dean Eliott5. 1. Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts; Department of Ophthalmology, Southern California Permanente Medical Group, Baldwin Park, California; Eye Monitoring Center, Kaiser Permanente Southern California, Baldwin Park, California. 2. Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts. 3. Economic Research Service, United States Department of Agriculture, Washington, DC. 4. Retina Service, Department of Ophthalmology, Weill Cornell Medical College, New York, New York. 5. Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts. Electronic address: Dean_Eliott@meei.harvard.edu.
Abstract
PURPOSE: To describe the characteristics and outcomes of endogenous endophthalmitis. DESIGN: Retrospective case series. PARTICIPANTS: Patients with endogenous endophthalmitis. METHODS: A retrospective chart review of patients diagnosed with endogenous endophthalmitis between September 1, 2006, and November 1, 2014. MAIN OUTCOME MEASURES: Clinical findings, treatments, microbial results, visual outcomes, and secondary ocular sequelae. RESULTS: Sixty-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 = 25) and 43% (n = 29) of eyes, respectively. In 47% of eyes (n = 32), the disease was associated with intravenous drug use. Eighteen percent of eyes (n = 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 = 3) received only systemic treatment. Seventy-eight percent of eyes (n = 53) underwent initial bedside aspirate with intravitreal injection of antibiotics (tap-and-injection), of which 55% (n = 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 = 11/21) despite all but 1 having received appropriate antimicrobial coverage initially. Fifty-four percent of eyes (n = 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 = 0.037). Eyes that underwent initial tap-and-injection were statistically significantly more likely to require a secondary PPV (55% vs. 0%; P = 0.0006) and had fewer positive microbial results (19% vs. 67%) than those that underwent initial PPV (P = 0.002). CONCLUSIONS: Most 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.
PURPOSE: To describe the characteristics and outcomes of endogenous endophthalmitis. DESIGN: Retrospective case series. PARTICIPANTS: Patients with endogenous endophthalmitis. METHODS: A retrospective chart review of patients diagnosed with endogenous endophthalmitis between September 1, 2006, and November 1, 2014. MAIN OUTCOME MEASURES: Clinical findings, treatments, microbial results, visual outcomes, and secondary ocular sequelae. RESULTS: Sixty-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 = 25) and 43% (n = 29) of eyes, respectively. In 47% of eyes (n = 32), the disease was associated with intravenous drug use. Eighteen percent of eyes (n = 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 = 3) received only systemic treatment. Seventy-eight percent of eyes (n = 53) underwent initial bedside aspirate with intravitreal injection of antibiotics (tap-and-injection), of which 55% (n = 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 = 11/21) despite all but 1 having received appropriate antimicrobial coverage initially. Fifty-four percent of eyes (n = 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 = 0.037). Eyes that underwent initial tap-and-injection were statistically significantly more likely to require a secondary PPV (55% vs. 0%; P = 0.0006) and had fewer positive microbial results (19% vs. 67%) than those that underwent initial PPV (P = 0.002). CONCLUSIONS: Most 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.
Authors: Ji Hwan Lee; Hee Suk Kim; Suk Ho Byeon; Sung Soo Kim; Hyoung Jun Koh; Sung Chul Lee; Christopher Seungkyu Lee Journal: Int Ophthalmol Date: 2022-04-17 Impact factor: 2.029