Author: Eric Kirkegaard Biosca (Spain)
Co-authors: Monica Berges Marti, Brahim Azarfane, Anna Boixadera Espax, Jose Garcia Arumi
Purpose
The aim of this study was to review the number and type of infectious endophthalmitis seen in the emergency ophthalmology service in a tertiary-referral hospital from January 2010 to March 2020. This study also evaluated the diagnostic yield of the different intraocular fluid (aqueous and vitreous samples), as well as blood culture yield when performed
Setting/Venue
Retinal Department of a tertiary-referral hospital (Vall d'Hebron Hospital, Barcelona, Spain)
Methods
This was a retrospective study including 106 patients (110 eyes) with clinical diagnosis of infectious endophthalmitis from January 2010 until March 2020 in our hospital. Electronic medical records, as well as microbiology and pathology results were reviewed. All patients had signs and symptoms consistent with infectious endophthalmitis such as redness, pain, decreased vision, >2+ anterior chamber cells, hypopyon, fibrin and/or vitreous haze, as well as a surgical history or a local or systemic infectious focus. Eyes were divided in exogenous (Group 1) or endogenous endophthalmitis (Group 2). Subsequently, Group 1 was divided according to the etiology of exogenous endophthalmitis (postoperative, traumatic, filtering-bleb associated, after intravitreal injection, corneal ulcer associated or other causes). Among Group 1, the diagnostic yield of the cultures of aqueous and vitreous samples was reviewed. In Group 2, blood cultures were also analysed.
Results
The series included 106 patients. In 4 patients the disease was bilateral, so 110 eyes were diagnosed with infectious endophthalmitis. In Group 1, 90 eyes were included. Among this group, 32 endophthalmitis were secondary to cataract surgery, 15 happened after intravitreal injection, 14 occurred after pars plana vitrectomy, 11 were attributable to an extension of corneal infection, 7 were due to bleb infection 6 were caused by a penetrating trauma (with or without intraocular foreign body) and 5 were related to other causes. Group 2 included 20 eyes of 16 patients. 78 samples of aqueous humor cultures were performed before starting antibiotic therapy (71 in Group 1 and 7 in Group 2) with a positive result in 22 eyes (31%) and 1 eye (14.3%) respectively. Vitreous cultures were done in 17 patients of Group 1, with a positive result in 6 eyes (35.3%), and in 7 cases of Group 2, with a positive result in 3 eyes (42.8%). In all cases, the vitreous sample was performed by a vitreoretinal surgeon after starting antibiotic therapy. Blood culture tests were analysed in 16 patients of Group 2, getting a positive result in 8 cases.
Conlusions
Endophthalmitis is a severe eye infection that can lead to irreversible vision impairment and even loss of the eye. Exogenous endophthalmitis is the most common etiology representing 90 cases (84.9%) in our series, being cataract surgery (35.5%) and intravitreal injections (16.6%) the procedures that cause it most frequently, especially because they are performed with great assiduity in our clinical practice. Endogenous endophthalmitis was diagnosed in 17 patients (16.1%). It is a less common etiology and it is important to suspect it in cases of bilateral disease and when there is no surgical or traumatic history or if there is a distant infection. The diagnosis is clinical, but it is important to search for the causative agent for treatment. Aqueous humor culture is the most widely used test but it is the one with the lowest yield in our series, getting a positive result only in 23 of the samples performed (29.5%), which represents a poorer result compared to the 9 positive results (37.5%) among vitreous culture, even antibiotic treatment had already been established. When endogenous endophthalmitis is suspected, blood culture is a good diagnostic tool with a positive result in 50% of the cases.
Financial Disclosure
No financial disclosure
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