Clinical features of infectious endophthalmitis in South Korea: a five-year multicenter study

Abstract

Background: To investigate clinical features of infectious endophthalmitis over five years in a South Korean population.

Methods: Medical records of consecutive patients diagnosed with infectious endophthalmitis at eight institutions located in Gyeongsangnam-do and Pusan city between January 1, 2004 and July 31, 2010 were reviewed.

Results: A total of 197 patients were diagnosed and treated. An average of 30.0 infectious endophthalmitis per year was developed. The annual incidence rate of postoperative endophthalmitis during 2006~2009 was 0.037%. The ratios of male to female and right to left were 50.2%: 49.8 % and 54.8%: 43.2%, respectively. Eighth decade and spring were the peak age (36.6%) and season (32.0%) to develop the infectious endophthalmitis. The most common past history in systemic disease was hypertension (40.4%), followed by diabetes (23.4%). Cataract operation (60.4%) was the most common cause, among which most of them was uneventful phacoemulsification (95.9%). Corneal laceration (51.6%) and liver abscess (42.9%) were the most common causes of traumatic and endogenous endophthalmitis, respectively. The percentages of patients with initial and final visual acuity less than counting fingers were 62.6% and 35.2%, respectively. Treatment with vitrectomy with or without intravitreal antibiotics injection was administered to 72.6% of patients, while 17.3% received intravitreal antibiotics only.

Conclusions: Our study revealed that the development of infectious endophthalmitis was related with seasonal variation and increased during our study period. Pars plana vitrectomy was preferred for the treatment of infectious endophthalmitis in South Korea.

Figure 1

Total number and incidence of infectious endophthalmitis and postoperative endophthalmitis in Gyungsang-do area, South Korea. A. Total number of infectious endophthalmitis from 2004 to 2009 in Gyungsang-do area. Annual average number of infectious endophthalmitis was 30.0 cases/year (197 cases/6.5 year). B. Incidence rates of postoperative infectious endophthalmitis which was induced from division the number of postoperative infectious endophthalmitis by the number of cataract operation showed stepwise increase after 2006. C. Total number of infectious endophthalmitis from 2004 to 2009 stratified by season. The data of 2010 was excluded from the graphs (A and B) due to not enough data period. D. Incidence rate of postoperative infectious endophthalmitis stratified by season showed that spring was the highest season to develop the endophthalmitis.

Figure 2

Age distribution of infectious endophthalmitis in South Korea. Average 66.9 ± 15.3 years.

Figure 3

Causes of infectious endophthalmitis in South Korea.

Figure 4

Time interval between inciting event, symptom occurrence, and intervention in infectious endophthalmitis patients. A. Duration of period from inciting event to symptom occurrence. The average duration was 29.8 ± 179.9 days. The number of cases in which the duration was over 14 days was 17 cases. B. Duration of period from symptom occurrence to intervention. The average duration was 3.9 ± 11.2 days. The number of cases in which the duration was over 14 days was 4 cases.

Figure 5

Distribution of initial visual acuity (VA) and final VA in infectious endophthalmitis patients. CF; Counting finger, LP; Light perception, HM; Hand movement, NLP; No light perception. All visual acuity examination was evaluated with Snellen chart.