Predictors of Visual Outcomes and Microbial Profile in Endophthalmitis

To evaluate predictors of visual outcomes and microbial profile in endophthalmitis.

This was a prospective, interventional case series at a tertiary eye care center. Of the 207 patients included, 83 had post-cataract surgery endophthalmitis (PCE), 84 had post-traumatic endophthalmitis (PTE), and 16 had endogenous endophthalmitis. Vitreous samples were evaluated for microbial profile, and all patients received similar empirical antibiotic therapy. Main outcome measures were good visual acuity, defined as better than 20/400, and microbial profile with drug resistance.

Final visual acuity better than 20/400 was seen in 88% patients previously treated with intravitreal antibiotics (P < .001), 89% with presenting vision of less than 3.3 LogMAR units (P < .001), 61% without retinal detachment (RD) (P < .001), 58% without retained intraocular foreign body (RIOFB) (P = .007), 88% without extensive media haze (P = .007), 71% of culture-negative patients (P = .007), and 65% with gram-positive bacteria (P = .03). On multivariate analysis, presenting visual acuity of less than 3.3 LogMAR units was found to have the highest adjusted odds ratio, 26.28 (95% CI, 9.13-75.6), for better visual outcome. Culture positivity was nearly 37%. Gram-positive bacteria were the most common in both PCE (90%) and PTE (55%) groups, whereas hyphae form fungus was the most common organism grown in endogenous endophthalmitis (50%) (P < .001). In patients without extensive media haze, hyphae form fungus was the most common grown organism (42%) (P = .03). PTE was predominant (60%) in the patients with antibiotic resistance.

Presenting visual acuity better than hand motions close to face is the single most common indicator of good visual prognoses. Fungal infections are associated with RD, RIOFB, trauma, and absence of extensive media haze. Microbial resistance may be an important concern in PTE patients. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:991-998.].