Abstract
Purpose. Endogenous endophthalmitis (EE) is a rare ocular disease caused by bacterial or fungal infection of intraocular spaces by hematogenous spread of pathogens from distant infectious loci in the body. We investigated the clinical characteristics and management of eyes with EE in ten consecutive patients. Methods. Ten patients (10 eyes) with EE treated at Tokyo Medical University Hospital in 2014 were reviewed. We retrospectively studied the causative organisms, systemic complications, pre/postoperative mean best-corrected visual acuity (BCVA), and status of posterior vitreous detachment (PVD). Results. The 10 patients comprised 8 males and 2 females, with mean age of 71.2 years. The causative organisms were bacteria in 6 eyes and fungi in 4 eyes. Systemic complications included septicemia or disseminated intravascular coagulation in 5 patients and diabetes mellitus in 4 patients. Postoperative BCVA was improved by 0.2logMAR or greater in 4 eyes and decreased in 4 eyes. Vitrectomy was performed in all eyes, and 4 required multiple surgeries. During vitrectomy, PVD was absent in 8 eyes, 4 of which showed retinal necrosis. The mean age of patients with no PVD was 71.2 years. Conclusion. Despite an advanced age, PVD was absent in the majority of patients with EE. PVD may be related to the pathogenesis and aggravation of EE.
Highlights
Metastatic endogenous endophthalmitis is a potentially sightthreatening intraocular infection resulting from hematogenous spread of microorganisms from a distant infective source within the body
The causative microorganisms isolated from vitreous fluid samples collected during surgery and from blood cultures were bacteria in 6 eyes and fungi in 4 eyes
Among the 4 eyes with fungal endophthalmitis, the fundus was visible in 3 eyes and difficult to observe in only 1 eye
Summary
Metastatic endogenous endophthalmitis is a potentially sightthreatening intraocular infection resulting from hematogenous spread of microorganisms from a distant infective source within the body. The incidence of endogenous endophthalmitis is far lower than that of exogenous endophthalmitis including postoperative endophthalmitis, accounting for only 2 to 8% of all endophthalmitis cases [1, 2]. The causative microorganisms are divided into bacteria and fungi, most commonly Candida species. Bacterial infections spread rapidly to intraocular tissues and require urgent management. Basic local treatments for endogenous endophthalmitis include intravitreal injection of antibacterial or antifungal agents against the causative microorganisms as well as vitrectomy. Frequent instillation of ceftazidime and vancomycin eye drops after surgery is an accepted treatment for bacterial endophthalmitis [6, 7] and should be started as soon as possible after operation
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