Visual Outcomes in Cases of Endogenous Endophthalmitis: A Multicenter Study

Abstract

Purpose: To assess factors affecting visual outcomes in endogenous endophthalmitis (EE).

Design: Retrospective cohort study from 8 tertiary care centers.

Participants: Eyes with EE and at least 4 weeks of follow-up.

Methods: Demographics, visual acuity (VA), vitrectomy use, and microbial cultures from blood, aqueous, or vitreous fluid were collected and evaluated relative to change in VA and enucleation/evisceration.

Main outcome measures: Presenting VA and microbial culture results associated with improvements to VA.

Results: Two hundred sixty-two eyes from 231 patients diagnosed with EE were evaluated. Eyes presenting with VA of either count fingers or hand motion (CF/HM) had significantly greater improvement in VA, compared with eyes presenting with either VA ≥20/800 or VA of light perception (LP) or no LP (less than or equal to LP) (P < 0.01). Twenty-eight eyes underwent enucleation/evisceration, and 23 (82.1%) of these eyes had VA less than or equal to LP at presentation. Forty-six point 9 percent of all study eyes (139 of 262) were from patients with positive blood cultures. Positive growth from blood cultures was associated with greater odds of VA improvement (odds ratio [OR]: 1.78, confidence interval [CI]: 1.07-2.95, P = 0.03) in all study eyes and reduced odds of enucleation/evisceration in eyes presenting with VA less than or equal to LP (OR: 0.12, CI: 0.04-0.42, P < 0.001). Compared with eyes from patients with positive blood cultures, eyes from patients with negative blood cultures had significantly lower rates of treatment with both systemic antimicrobials and intravitreal antimicrobial injections (P < 0.001). In eyes from patients with negative blood cultures, there was a trend for greater improvement after initial treatment with both antibacterial and antifungal injections compared with initial treatment with either antibacterial or antifungal injection alone (P = 0.05).

Conclusions: Eyes presenting with a VA of CF/HM have the greatest potential for VA improvement. Patients with EE without any organisms identified on blood cultures may benefit from broad initial intravitreal antimicrobial coverage to reduce the odds of worsening VA.

Financial disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Keywords: Bacteremia; Endogenous endophthalmitis; Fungemia; Intravitreal injections; Pars plana vitrectomy.