[Endogenous bacterial endophthalmitis: a retrospective study on 22 consecutive cases]

Area of Science:

• Ophthalmology
• Infectious Diseases
• Surgical Innovation

Background:

• Endogenous bacterial endophthalmitis presents significant challenges in diagnosis and treatment.
• Predisposing factors include severe conditions like diabetes mellitus, renal insufficiency, and urinary tract infections.
• Identifying causative organisms and optimizing treatment strategies are critical for visual prognosis.

Purpose of the Study:

• To analyze predisposing factors, diagnostic timing, infection sources, and visual outcomes in endogenous bacterial endophthalmitis.
• To evaluate the efficacy of immediate vitrectomy versus solely intravitreal antibiotics.

Main Methods:

• Retrospective review of 22 consecutive endogenous bacterial endophthalmitis cases over nine years.
• Systemic antibiotics for identified infection sources.
• Intraocular antibiotic injections, often combined with pars plana vitrectomy.

Main Results:

• Most patients (90%) had severe predisposing conditions, with 70% having diabetes mellitus, renal insufficiency, and urinary tract infections.
• Gram-positive bacteria (75%) were more common, with Staphylococcus aureus and S. epidermidis being prevalent.
• Vitrectomy was the primary treatment in 73% of cases, resulting in light perception or better in 57% of eyes; early diagnosis (≤2 days) led to better outcomes (60%) compared to delayed diagnosis (33%).

Conclusions:

• Prompt diagnosis and intervention are paramount for positive outcomes in this ophthalmological emergency.
• Immediate pars plana vitrectomy with intraocular antibiotics appears to enhance the prognosis for affected eyes.
• Early treatment is significantly associated with improved visual function and globe salvage.