Lessons Learnt From 25 Years of Endophthalmitis: Causes, Microbiology and Visual Outcome Trends

We aimed to study the trends in microbiology, precipitating causes and outcomes of endophthalmitis in Victoria, Australia, over a 25-year period. To the best of our knowledge, this is the longest study of endophthalmitis in Australia.

We conducted a prospective study of all endophthalmitis cases to the Royal Victorian Eye and Ear Hospital, a state-wide tertiary referral centre for ocular conditions, thereby capturing nearly all state-wide endophthalmitis cases. All patients presenting with endophthalmitis were included. Demographic data, examination findings, microbiology, management and outcomes were collected.

A total of 1423 eyes from 1408 patients were included. The mean (SD) age was 71.35 (16.12). The median presenting best-corrected visual acuity was hand movements. Cataract surgery formed the plurality of annual cases until 2009; intravitreal injections exceeded following. The rate of endophthalmitis secondary to cataract surgery decreased from 0.29%-0.02% over the 25-year period, with a significant decrease following the introduction of prophylactic cefazolin; however, the rate of endophthalmitis secondary to intravitreal injections remained relatively stable (0.01%-0.04%). 63.03% were culture-positive; the plurality grew gram-positive bacteria (42.94%). Visual outcomes were biphasic; 44.99% had a final BCVA of less than 6/60 (including enucleation/evisceration), while 30.6% reached 6/12 or better. Poor visual outcomes were associated with corneal infection; cataract surgery and intravitreal injections were associated with better outcomes.

This study demonstrated declining rates of endophthalmitis secondary to cataract surgery and stable rates of endophthalmitis secondary to intravitreal injections. Visual outcomes were bimodal; while many do very poorly, some have good visual recovery.