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Visual Acuity Influences Visual Outcome in Endophthalmitis: A 10-Year Retrospective Observational Cohort Analysis
Yvonne Nowosielski1, Charlotte Erlacher2, Sarah Maier3
1Department of Ophthalmology and Optometry, Medical University of Innsbruck, Innsbruck, Austria. yvonne.nowosielski@i-med.ac.at.
Introduction:
Endophthalmitis is a severe, sight-threatening intraocular infection that may follow ophthalmic procedures or arise endogenously. Since the Endophthalmitis Vitrectomy Study (EVS, 1995), surgical and antimicrobial strategies have evolved. This study aimed to evaluate treatment approaches, microbial spectrum, and outcomes of endophthalmitis cases at the University Eye Clinic Innsbruck over the past decade.
Methods:
A retrospective observational cohort analysis of all patients treated for endophthalmitis between January 2013 and December 2023 was conducted. Cases were categorized as exogenous, endogenous, or keratitis-related. Data on etiology, treatment, time to intervention, microbial isolates, and best-corrected visual acuity (BCVA, logMAR) were assessed. Treatment included tap and inject, pars plana vitrectomy (PPV) within 24 h after presentation, or delayed surgery. Regression analyses identified predictors of visual outcome and re-intervention.
Results:
A total of 118 eyes from 110 patients (median age 72 years) were included. Exogenous cases accounted for 60.2%, endogenous for 28.8%. Median BCVA at diagnosis was 2.3 logMAR, improving to 1.0 logMAR at 6 months. Pathogens were isolated in 58.5% of cases-mainly Staphylococcus epidermidis (57%) in exogenous and Candida albicans (20.6%) in endogenous infections. Median time to intervention in exogenous cases was 3.5 h. BCVA at diagnosis and timepoint were significantly associated with visual outcome over time (p < 0.001, respectively; exogenous cases only). Re-intervention was required in 78 eyes; hazard was significantly higher after delayed surgery in exogenous cases (HR of 5.7, 95% CI [2.9-11.1], p < 0.001 (n = 71, 39 re-interventions).
Conclusions:
Visual acuity remains the main prognostic factor for visual recovery. In exogenous endophthalmitis, delayed surgery is associated with a high re-intervention rate, which may be reduced by initial tap-and-inject treatment. Prospective studies are needed to establish optimal timing and treatment strategies.
