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. 2018 May 3;18(1):112.
doi: 10.1186/s12886-018-0777-3.

Microbial keratitis-induced endophthalmitis: incidence, symptoms, therapy, visual prognosis and outcomes

Daniel Zapp  1 , Daria Loos  1 , Nikolaus Feucht  1 , Ramin Khoramnia  2 , Tamer Tandogan  2 , Lukas Reznicek  1 , Christian Mayer  3
Affiliations

Microbial keratitis-induced endophthalmitis: incidence, symptoms, therapy, visual prognosis and outcomes

Daniel Zapp et al. BMC Ophthalmol. .

Abstract

Background: To evaluate symptoms, therapies and outcomes in rare microbial keratitis-induced endophthalmitis.

Methods: Retrospective study with 11 patients treated between 2009 and 2014. Clinical findings, corneal diseases, history of steroids and trauma, use of contact lenses, number and type of surgical interventions, determination of causative organisms and visual acuity (VA) were evaluated.

Results: The incidence of transformation from microbial keratitis to an endophthalmitis was 0.29% (n = 11/3773). In 90.9% (n = 10/11), there were pre-existent eyelid and corneal problems, in 45.5% (n = 5/11) rubeosis iridis with increased intraocular pressure and corneal decompensation, and in 18.2% (n = 2/11), ocular trauma. Specimens could be obtained in 10 of 11 samples: 33.3% of those 10 specimens were Gram-positive coagulase-negative Staphylococci (n = 3/10) or Gram-negative rods (n = 3/10) and 10.0% Staphylococcus aureus (n = 1/10). In 30% (n = 3/10), no pathogens were identifiable. 72.7% (n = 8/11) of all keratitis-induced endophthalmitis were treated with vitrectomy and 9.1% (n = 1/11) with amniotic-membrane transplantation. In 27.3% (n = 3/11) the infected eye had to be enucleated - 18.2% (n = 2/11) primarily, 9.1% (n = 1/11) secondarily. No patient suffered from sympathetic ophthalmia. The median initial VA was 2.1 logMAR (n = 11/11). At one month, median VA was 2.0 logMAR (n = 7/11), after three months 2.0 logMAR (n = 6/11), and after one year 2.05 logMAR (n = 6/11). The change in VA was not significant (p > 0.99). 36.4% (n = 4/11) of the cases resulted in blindness.

Conclusions: The overall outcome is poor. Enucleation should be weighed against the risk of local and systemic spread of the infection, prolonged rehabilitation and sympathetic ophthalmia.

Keywords: Corneal ulcer; Endophthalmitis; Enucleation; Infection; Keratitis.

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Conflict of interest statement

Ethics approval and consent to participate

The study was conducted in accordance with the tenets of the Declaration of Helsinki and approved by the internal Institutional Review Board of Klinikum rechts der Isar, Technical University of Munich.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Clinical image of microbial keratitis-induced endophthalmitis. The diagnosis is determined by clinical findings: visual acuity decrease, pain, hypopyon and vitreous body infiltration
Fig. 2
Fig. 2
Prevalence of microbial keratitis-induced endophthalmitis in comparison to all triggers of endophthalmitis (in %)
Fig. 3
Fig. 3
Microbial detection in microbial keratitis-induced endophthalmitis (percentage and number). Seven of 11 specimens revealed microbials
Fig. 4
Fig. 4
Development of visual acuity (logMAR) in microbial keratitis-induced endophthalmitis: Day 0 = initial presentation, 1 m = 1 month, 3 m = 3 months, 1y = 1 year: at no time was there a statistically significant improvement in visual acuity (all p > 0.05 respectively)
Fig. 5
Fig. 5
Visual acuity change in logMAR in the four different endophthalmitis aetiologies: post-operative, traumatic, microbial keratitis-induced and endogenous
See this image and copyright information in PMC

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