Clinical Course and Characteristics of Eyes with Recurrent Episodes of Endophthalmitis

Infectious endophthalmitis is a devastating, yet rare, complication after intraocular surgery, trauma, and systemic illness. Given its rare incidence, few patients would be expected to experience more than 1 episode of infectious endophthalmitis in their lifetime. We reviewed our patients who were diagnosed with and treated for at least 2 separate episodes of endophthalmitis.

A retrospective, consecutive case series was conducted of patients managed at Associated Retinal Consultants PC (Royal Oak, Michigan) from January 2013 through December 2019.

Patients were identified with the diagnosis of endophthalmitis by International Classification of Diseases, Ninth and Tenth Editions, codes.

Those diagnosed and then treated either with a vitreous tap and intravitreal injection of antibiotics or with pars plana vitrectomy at least twice were included. Those treated multiple times for the same episode of endophthalmitis were excluded.

Cause and risk factors for recurrent endophthalmitis.

Charts of 535 patients were reviewed, and 12 patients met inclusion criteria. The median age at initial presentation was 72.5 years, and 33.3% were men. Eight of the 12 patients (66%) experienced recurrent endophthalmitis in the same eye, and 4 of the 12 patients (33%) experienced separate episodes in different eyes. The average time between episodes was 604 days (range, 90-2366 days). The average follow-up from the second episode was 492 days (range, 119-1185 days). The most common cause for both the first and second episodes was recent intravitreal injection (50% and 58.3%, respectively) followed by surgery associated (41.6% and 33.3%, respectively). The cause was the same for the first and second episodes of 8 patients (75%). Of the 24 recorded episodes of endophthalmitis, culture results were positive in 41.6%, with coagulase-negative Staphylococcus being the most common bacteria identified.

Recurrent endophthalmitis is rare and seen most commonly after intravitreal injections. Most patients in this series showed culture-negative results. Each successive episode of endophthalmitis was associated with a worse final visual outcome. The cumulative number of intravitreal injections may be an independent risk factor for recurrent postinjection endophthalmitis.