Endogenous endophthalmitis: a 10-year review of culture-positive cases in northern China

Abstract

Purpose: The aim of this study was to report the clinical features and treatment outcomes in a series of patients with endogenous endophthalmitis treated over a 10-year period in a single hospital in northern China.

Methods: The authors conducted a retrospective chart review of 19 patients (23 eyes) treated for culture-proven endogenous endophthalmitis at the First Hospital of China Medical University between 1998 and 2007.

Results: Patients were followed up for a mean of 15.9 months (range: 0.5-41 months). The main systemic predisposing risk factors were diabetes mellitus (52.6%), immunosuppressive therapy (36.8%), and malignancies (31.6%). Fungal isolates were present in 14 eyes (60.9%), gram-positive isolates in 8 eyes (34.8%), and gram-negative isolates in 1 eye (4.3%). All patients received intravenous antibiotics or antifungal agents, and other treatments included injection of intravitreal medication in 7 eyes (30.4%) and pars plana vitrectomy with injection of intravitreal medication in 14 eyes (60.9%). Final visual outcomes were obtainable for 21 eyes (one patient died 15 days after diagnosis). Ten (47.6%) of these 21 eyes achieved a visual acuity of 20/400 or better, and 11 (52.4%) achieved a visual acuity worse than 20/400, including 5 that were eviscerated. The median visual acuity was counting fingers (range: 20/25 to no light perception). Eyes with endophthalmitis caused by Candida species tended to have better visual outcomes than did eyes with bacterial and Aspergillus causes.

Conclusions: Similar to the findings of previous studies, this study showed that fungi, especially Candida species, were the most common causative organisms of endogenous endophthalmitis. Endogenous endophthalmitis is generally associated with poor visual acuity outcomes, particularly when caused by more virulent species of fungi, such as Aspergillus.