Endogenous endophthalmitis in a tertiary referral centre: a 14-year case series with comparative perspective

Endogenous endophthalmitis (EE) is a rare but severe ocular emergency caused by haematogenous spread of infectious microorganisms. This study analyses clinical characteristics, diagnostic challenges, microbiological spectrum, and treatment outcomes of EE cases over a 14-year period, comparing findings with published data.

A retrospective review was conducted on EE cases diagnosed at a tertiary care centre from 2010 to 2024. Data included demographics, clinical presentation, microbiology, diagnostics, treatment, and visual outcomes. Relevant literature was reviewed to contextualise findings and reflect on similarities and nuances in broader clinical experience.

27 patients with EE were identified. Systemic comorbidities, including malignancies and immunosuppression, were common. Ocular symptoms were present in 77% of cases, while 22% were asymptomatic. The majority exhibited unilateral involvement. Blood cultures (BC) were performed in 77% of cases, with a positivity rate of 66%. Vitreous biopsies were conducted in nine cases, yielding a 66% positivity rate. Treatment included systemic antibiotics or antifungals, topical medications, and intravitreal therapy (81% of cases). Pars plana vitrectomy (PPV) was performed in 51% of cases, though only two underwent early PPV. Final BCVA varied widely, with 59% of eyes achieving functional recovery. 21% of cases resulted in phthisis bulbi or evisceration, and 18% of patients died during follow-up due to systemic illness.

EE presents diagnostic and therapeutic challenges, with high risk of visual impairment and systemic morbidity. Early recognition, aggressive therapy, and timely surgery may improve outcomes. Further research is needed to establish standardised diagnostic and treatment guidelines for optimal management.