Clinical Features Associated with Poor Prognosis in Endogenous Endophthalmitis: New Insights from a 5-Year...

Endogenous endophthalmitis (EE) is a rare, vision-threatening intraocular infection. This study evaluated the clinical profiles, risk factors, microbiological spectrum, and outcomes of EE at a tertiary hospital in Malaysia. It also aimed to identify prognostic factors affecting visual and anatomical outcomes.

A 5-year retrospective review of medical records of patients diagnosed with EE between 2020 and 2024.

Forty-one eyes from 33 patients were included. The mean age was 53.0 (SD 13.1) years. Diabetes mellitus was the predominant comorbidity (87.9%). Klebsiella pneumoniae was the most common isolated pathogen in blood (18.2%) and vitreous (22.0%) cultures. Median follow-up duration was 4 months, with a median final visual acuity of 1.0 (0.2-2.9) logMAR. Evisceration was performed in 22.0% of eyes, while pthisis bulbi occurred in 4.9%. In multivariable generalized estimating equations (GEE) analysis, swollen eyelids (adjusted OR [aOR] = 30.660 (95% CI 2.190, 429.209); p = 0.011) and Klebsiella pneumoniae infection (aOR = 27.690 (95% CI 1.978, 387.579); p = 0.013) were associated with poor visual outcome. The first-year globe survival rate was 66.2% (95% CI 45.4, 87.0). Ocular pain (adjusted HR [aHR] = 3.782 (95% CI: 1.141, 12.540), p = 0.030) and Klebsiella pneumoniae infection (aHR = 7.147 (95% CI: 1.620, 31.540), p = 0.009) were associated with an increased risk of globe loss.

Swollen eyelids and ocular pain are critical red flags for poor prognosis in EE. Klebsiella pneumoniae infection remains a key negative predictor. Early identification of these clinical features is essential to salvage vision and the globe in EE.