Epidemiology, Microbiology, Management and Outcomes of Endophthalmitis: An 18 Year Retrospective Observational Study...

This study characterizes the epidemiology, microbiological profile, management and outcomes of endophthalmitis over 18 years at a tertiary referral center in regional New South Wales (NSW), Australia.

A retrospective observational study of all endophthalmitis cases at John Hunter Hospital (November 2006 to December 2024) identified via ICD-10 codes and confirmed via record review. Data included demographics, clinical presentation, etiology, microbiology, management and surgical interventions.

In total, 232 cases (227 patients) were identified (median age 75.6 years). Annual incidence declined significantly (slope = -0.17 cases/year, 95% CI -0.29 to -0.052); p = 0.005). Exogenous endophthalmitis accounted for 87.1% of cases, most commonly following cataract surgery or intravitreal injection (38.1% each). Endogenous cases (12.9%) were mainly associated with bacteremia (56.7%) and immunosuppression (20%). Culture positivity was 56%, with 97.7% of isolates being bacterial. Gram positive cocci were identified in 84% of culture-proven cases, predominantly coagulase-negative staphylococci (42%), while gram-negative organisms comprised 9.4%. Intravitreal antibiotics were administered in 97.3% of cases and pars plana vitrectomy (PPV) performed in 41.5%. Overall, 52.5% of eyes improved in visual acuity. The Win Ratio for improvement with vitrectomy versus antibiotics alone was 1.31 in favor of vitrectomy (95% CI 0.77-2.22; p = 0.31). In eyes presenting with light perception vision, the Win Ratio was 2.28 in favor of vitrectomy (95% CI 0.79-6.55; p = 0.13).

Exogenous endophthalmitis remains the leading cause of endophthalmitis at a major regional tertiary referral center. Findings align with the Endophthalmitis Vitrectomy Study, suggesting vitrectomy benefits mainly eyes presenting with light perception only vision.