Chronische endogene Endophthalmitis

Abstract

An endogenous endophthalmitis is a severe, potentially blinding intraocular infection due to haematogenous spread of germs. In Europe, gram-positive bacteria and Candida albicans are common causative organisms. Compared to post-operative cases of endophthalmitis, endogenous endophthalmitis is relatively rare, accounting for 2-8% of all endophthalmitis cases. Most patients suffer from an underlying disease causing some kind of immunodeficiency. Other predisposing factors are long-term therapy in intensive-care units (ICU), intravenous catheters, iatrogenic immunosuppression or intravenous drug abuse. Final visual acuity strongly depends on the time needed for the correct diagnosis, the infectious agent and the selection of adequate treatment. Identification of the infectious agent by vitreous biopsy and blood cultures enables the ophthalmologist to choose a specific antibiotic treatment. Therapy consists of topical, intravitreal and systemic antibiotics or antimycotics often in combination with steroids and pars plana vitrectomy. As many of the patients with endogenous endophthalmitis are initially misdiagnosed (e. g. uveitis), it is important to consider this disease in the presence of suspicious symptoms.