Visual Outcomes in Cases of Endogenous Endophthalmitis: A Multicenter Study

Area of Science:

• Ophthalmology
• Infectious Diseases
• Retinal Surgery

Background:

• Endogenous endophthalmitis (EE) is a severe intraocular infection requiring prompt diagnosis and management.
• Visual outcomes in EE are variable and influenced by numerous factors.
• Understanding these factors is crucial for optimizing treatment strategies and improving patient prognosis.

Purpose of the Study:

• To identify key factors influencing visual acuity (VA) outcomes in patients with endogenous endophthalmitis (EE).
• To evaluate the impact of presenting VA, microbial culture results, and treatment modalities on visual recovery and the need for enucleation/evisceration.

Main Methods:

• A retrospective cohort study was conducted across 8 tertiary care centers.
• Data from 262 eyes of 231 patients diagnosed with EE were analyzed.
• Factors evaluated included demographics, presenting VA, vitrectomy use, and microbial cultures (blood, aqueous, vitreous) relative to VA change and enucleation/evisceration.

Main Results:

• Eyes presenting with visual acuity of count fingers/hand motion (CF/HM) demonstrated significantly greater VA improvement compared to those with VA ≥20/800 or light perception (LP) or worse.
• Positive blood cultures were associated with improved VA and reduced odds of enucleation/evisceration, particularly in eyes with presenting VA ≤LP.
• Eyes with negative blood cultures received less systemic and intravitreal antimicrobial treatment, and showed a trend towards better outcomes with combined antibacterial and antifungal injections.

Conclusions:

• Presenting visual acuity of CF/HM indicates the highest potential for VA improvement in endogenous endophthalmitis.
• For EE patients with negative blood cultures, empiric broad-spectrum intravitreal antimicrobial coverage may be beneficial to prevent vision deterioration.