Clinical Decision Making and Visual Outcomes in Endophthalmitis Treated with Systemic Corticosteroids

Abstract

To characterize practice patterns and compare visual outcomes in patients with endophthalmitis who did or did not receive systemic corticosteroid therapy. Retrospective, nonrandomized comparative trial. Eyes diagnosed with endophthalmitis at the Duke Eye Center between January 1, 2009, and January 1, 2018, with at least 6 months of follow-up from the time of initial diagnosis. Retrospective chart review identified 133 eyes of 130 consecutive patients meeting inclusion criteria. Clinical presentation, initial management decisions, and subsequent outcomes and complications were assessed. Visual acuity (VA) at presentation with endophthalmitis and at 6 months were assessed for each patient. Eyes treated with systemic corticosteroid therapy were identified for further analysis. Factors associated with oral steroid use on binary logistic regression analysis and improvement in VA 6 months after endophthalmitis. Of 133 eyes with endophthalmitis, 33 (25%) received oral steroids. Oral steroid use was associated with culture-positive endophthalmitis (odds ratio [OR] 2.7; 95% confidence interval [CI], 1.2-6.2), hypotony (OR, 4.2; 95% CI, 1.3-13.6), conjunctival hyperemia (OR, 2.6; 95% CI, 1.02-6.5), and anterior chamber fibrin on examination (OR, 2.7; 95% CI, 1.1-6.3). Eyes with endogenous endophthalmitis were less likely to receive oral steroids (OR, 0.2; 95% CI, 0.05-0.92). Eyes treated with oral steroids were more likely to show VA improvement of 3 lines or more after endophthalmitis (OR, 2.8; 95% CI, 1.1-6.7) and to exhibit greater improvement from presentation to month 6 (-1.102 logarithm of the minimum angle of resolution [logMAR] vs. -0.655 logMAR; P=0.024). Systemic corticosteroid therapy was associated with improved visual outcomes in endophthalmitis. The decision to administer oral steroids was significantly associated with hypotony, conjunctival hyperemia, and fibrinous reaction on presentation. Culture-positive cases were more likely to receive oral steroids, whereas patients with endogenous endophthalmitis were less likely to receive oral steroids. A prospective, randomized trial of systemic corticosteroid use in endophthalmitis may be warranted.