Abstract
To demonstrate the demographics, associated factors, clinical presentations, microbiology, management, visual outcome and complications of keratitis/scleritis-related endophthalmitis (KSE). A retrospective chart of all endophthalmitis patients diagnosed between September 2001 and August 2011 was reviewed. Only endophthalmitis cases with previous corneal or scleral infection were included in the study. The patients were followed until losing vision or eyeball, becoming phthisis, or the end of 2018. Eighty-seven patients with KSE were identified, all unilateral. The mean age was 56.4 ± 21.4 years. There was a slight male predilection (55 patients, 63.2%). The mean follow-up time was 50 ± 149 weeks. The causative pathogens were identified in 35 patients (40.2%), with the highest frequency being bacteria. The most common bacterium was Pseudomonas aeruginosa (n = 13), and the most common fungus was Aspergillus sp. (n = 5). Fifteen patients achieved (17.2%) final visual acuity (VA) of hand motion or better after treatment. Eyeball removal was performed in 61 (70.1%) patients. From multivariate analysis, the only prognostic factor for poor final VA (worse than hand motion, HM) was poor VA (worse than HM) at the initial visit (relative risk 1.97, 95% confidence interval 1.15–3.36, p = 0.013). KSE is uncommon but has a devastating outcome. We found that the patient’s initial VA was the only predictor for their final vision. P. aeruginosa was the most common identifiable organism in this study. However, several fungal infections were recognised. These findings should raise awareness for treatment of KSE in the tropics.
Highlights
Endophthalmitis, a severe infection inside the eye, is frequently caused by bacterial or fungal infection and leads to devastating sequelae
The study was approved by the Siriraj Institutional Review Board (SIRB), Siriraj Hospital, Bangkok, Thailand (Approval Number Si157/2012) and the need for informed consent was waived by the SIRB committee
From 416 patients diagnosed with endophthalmitis in our institution, 87 patients with keratitis/scleritis-related endophthalmitis (KSE) (20.9%) were identified and reviewed in this study
Summary
Endophthalmitis, a severe infection inside the eye, is frequently caused by bacterial or fungal infection and leads to devastating sequelae. To get rid of pathogen and prevent spreading of infection, most of KSE cases ended with evisceration or e nucleation[1,2,3,4,5,6,7,8,9,10] This disease resulted in much worse outcomes when compared with the other types of endophthalmitis[1]. There were few studies of KSE worldwide; almost all were from temperate or subtropical regions These reports demonstrated similarity in prognosis and causative pathogens. A report from Florida demonstrated a higher rate of fungal infection than other reports from cooler and drier a reas[2] From those studies, climatic differences may influence the type of causative agents for KSE. The findings would represent epidemiology of KSE from the tropics
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