The clinical spectrum of endophthalmitis: incidence, predisposing factors, and features influencing outcome

Endophthalmitis is a virulent ocular inflammation typically developing suddenly and progressing rapidly. To better understand the incidence and factors predisposing to infection and influencing outcome, records of 114 patients with endophthalmitis hospitalized at one institution from 1980 to 1986 were reviewed. An infectious origin was confirmed in 79 patients (69%). The most common pathogens included staphylococcal species (Staphylococcus epidermidis, 33 cases; Staphylococcus aureus, 8 cases), streptococci (18 cases), gram-negative organisms (10 cases), and fungi (7 cases). Predisposing factors for infective endophthalmitis included preceding ocular surgery (67%), penetrating trauma (13%), systemic infection (11%), and periocular infection (5%). Despite vitrectomies and aggressive use of antibiotics, 42 patients (53%) with infective endophthalmitis suffered major visual loss. Morbidity was less pronounced with infection caused by S. epidermidis (23%; P less than .05). Patients with infective endophthalmitis more likely required repeated vitrectomies, were hospitalized longer, and had a worse outcome (as measured by complete enucleation) than those with "sterile" endophthalmitis. On the basis of these data, empiric vancomycingentamicin might be initiated in patients with endophthalmitis. Studies to define optimal management are needed, because the morbidity associated with this entity remains pessimistically high despite state-of-the-art treatment.