Clinical features, antimicrobial susceptibilities, and treatment outcomes of patients with culture positive endophthalmitis after penetrating keratoplasty

Abstract

Purpose: To report the clinical features organisms and treatment outcomes in patients with endophthalmitis after penetrating keratoplasty (PK).

Methods: Retrospective noncomparative case series.

Results: Eleven eyes of 11 patients with culture positive endophthalmitis after PK were included. The time to diagnosis of endophthalmitis from last PK was less than 1 week in 3/11 (27%), between 1 and 4 weeks in 3/11 (27%), and greater than one month in 5/11 (46%) (range 2-924 days). The distribution of isolates included gram positive (GP) 9/11 (82%), gram negative (GN) 1/11 (9%), and fungal 1/11 (9%) species, respectively. Of GP bacteria tested, 9/9 (100%) were sensitive to Vancomycin. Of fungal isolates tested, none (0/1) were sensitive to Amphoteracin, Fluconazole, and/or Voriconazole. Among patients with rim culture data available, 1/7 (14%) donor rims were culture positive for Candida glabrata and 6/7 (86%) were culture negative. Patients were treated with primary tap and inject in 10/11 (91%) and primary vitrectomy in 1/11 (9%). VA of ≥5/200 was present in 2/11 (18%) at time of endophthalmitis diagnosis, and was recorded in 6/11 (55%) at last follow-up.

Conclusions and importance: Patients with endophthalmitis after PK presented at variable time points after surgery. Gram positive organisms were the most common isolate. VA outcomes after treatment were generally poor.

Keywords: BPEI, Bascom Palmer Eye Institute; CE, cataract extraction; DMEK, Descemet membrane endothelial keratoplasty; DSAEK, descemet stripping automated endothelial keratoplasty; Endophthalmitis; GN, gram negative; GP, Gram positive; HM, Hand motion; IOL, intraocular lens implant; LP, Light perception; NLP, No light perception; PK, penetrating keratoplasty; PPV, vitrectomy; Penetrating keratoplasty; TAP, tap and inject.

Fig. 1

Vitreous culture results in 11 patients.

Fig. 2

Case 3: Clinical photograph at time of endophthalmitis diagnosis, 9 days after PK. Marked conjunctival injection, intact corneal sutures, and dense fibrinous anterior chamber reaction are noted. The vitreous isolate was Streptococcus agalactiae. At last recorded visit, VA was LP due to corneal and anterior chamber opacity.

Fig. 3

Case 7: Clinical photograph at time of endophthalmitis diagnosis, 924 days after PK. Marked conjunctival injection, intact corneal sutures, and dense fibrinous anterior chamber reaction are noted. The vitreous isolate was Staphylococcus hominis. At last recorded visit, VA was 20/200 due to vitreous opacities and corneal edema.

Fig. 4

Clinical photograph at time of endophthalmitis diagnosis, 214 days after PK. Marked conjunctival injection, intact corneal sutures, and dense fibrinous anterior chamber reaction are noted. The vitreous culture was negative, thus this patient was not included in the current series. The anterior chamber isolate was Candida albicans. At last recorded visit, VA was 20/200 due to corneal edema after multiple repeat PKs and removal of pupillary membrane.