Central Nervous System Involvement in Patients with Endogenous Endophthalmitis: A Retrospective Study

The detrimental effects of endogenous endophthalmitis on visual acuity have been well studied; however, other complications of the central nervous system have not been robustly investigated. Our objective was to investigate central nervous system involvement associated with endogenous endophthalmitis.

We analyzed hospitalized patients with endogenous endophthalmitis in two hospitals from January 2010 to November 2020. We documented patient characteristics and outcomes related to endogenous endophthalmitis, including relevant neurologic complications. A neuroradiologist reviewed any available central nervous system imaging.

A total of 62 patients were included (42 [68%] males and 20 [32%] female). Of those included, 14 patients (23%) had at least one neurologic complication associated with the central nervous system. Of those 14 patients, 8 (57%) had ischemic/embolic brain infarction(s), 7 (50%) had encephalopathy, 4 (29%) had cerebral hemorrhage(s), 2 (14%) had meningitis, 1 (7%) had a brain abscess, and 1 (7%) had an anoxic brain injury. Of the patients who had central nervous system complications, a majority of eight patients (57%) had positive blood cultures, two (14%) had positive intraocular cultures, while two (14%) were positive in both. There was no statistically significant difference in demographics, comorbidities, source of infection, or organism between patients with and without central nervous system complications.

The incidence of comorbid central nervous system disease in our cohort was higher than previously reported in the literature. Although we identified no specific risk factors for the development of central nervous system disease in endogenous endophthalmitis, we found that cases with more severe central nervous system complications were associated with culture positivity.