Intravitreal Antibiotic Therapy Research Articles

A Case of Fulminant Serratia marcescens Panophthalmitis After Penetrating Keratoplasty

Purpose: To report the first case of fulminant Serratia marcescens panophthalmitis after penetrating keratoplasty (PK). Methods: This is a report of a patient who developed fulminant panophthalmitis shortly after undergoing PK with anterior chamber intraocular lens placement. Slit-lamp examination, B-scan ultrasound (B scan), and orbital computed tomography of the left eye (OS) were performed to further evaluate the patient. Tissue culture and histopathologic examination of the corneal specimen were completed to confirm the diagnosis. Results: A 78-year-old pseudophakic woman presented with 2 days of increasing pain, swelling, and purulent discharge after uneventful PK and secondary anterior chamber intraocular lens placement OS. Examination was notable for light perception without projection, elevated intraocular pressure of 48 mmHg, and a perforated corneal ulcer. B scan demonstrated diffuse vitreous opacities and membranes. Orbital computed tomography demonstrated proptosis and high-attenuation material within the left globe. Canthotomy, vitreous sampling, and antibiotic injections were performed. Corneal tissue cultures grew S. marcescens. Therapeutic PK was performed, but after rapid decompensation, the eye was eviscerated. Conclusions: This is the only reported case of fulminant S. marcescens panophthalmitis after PK. S. marcescens panophthalmitis is an aggressive and rapidly progressive infection with poor visual outcomes despite appropriate intravitreal and systemic antibiotic therapy.

Utility of multicolor imaging in endogenous endophthalmitis

The utility of multicolor imaging (MCI) has been well evaluated for various retinal disorders like age-related macular degeneration, retinal vascular occlusions, and central serous chorioretinopathy. However, the utility of MCI in endogenous endophthalmitis is very limited. We report a unique case of endogenous endophthalmitis showcasing the utility of MCI in monitoring the response of bacterial colonies to intravitreal antibiotic therapy.

Clinical Features of Patients with Penetrating Eye Injury and Foreign Body Complicated by Endophthalmitis

Purpose: to study the clinical features of patients with penetrating eye injury and foreign body, complicated by endophthalmitis.Methods. 68 patients (68 eyes) with penetrating injury and ocular foreign body were included in the retrospective study, including 91.2 % males and 8.8 % females. The mean age was 50.00 [32.00; 60.00] years. The patients were divided into 2 groups: with endophthalmitis — 24 patients, without inflammation — 44 patients. All patients underwent standard ophthalmologic methods of examination.Results. The age of patients with endophthalmitis was significantly greater compared to patients without inflammation — 51.50 [46.25; 63.25] years and 36.50 [31.25; 58.50] years, respectively (p = 0.0446). In the first day after injury, only 25 % of patients asked for medical care (p = 0.0071). In patients with endophthalmitis according to biomicroscopy data on admission the following were significantly more frequent: eyelid edema (p < 0.0001), purulent discharge (p < 0.0001), total hyphema (p = 0.029), hypopyon (p < 0.0001), iris edema (p < 0.0001), fibrin in vitreous body (p = 0.0014), as well as its destruction (p = 0.0005). 87.5 % of patients with endophthalmitis showed absence of fundus reflex (p = 0.0105), and 25 % of patients with inflammation showed increased intraocular pressure (p = 0.0019). In patients with endophthalmitis, surgical treatment was performed: cataract phacoemulsification in 91.7 % of patients (p < 0.0001), vitreoectomy in 87.5 % (p = 0.0098), enucleation of the eye in 12.5 % (p = 0.0165) and evisceration in 12.5 % (p = 0.0165). Bacterial culture in patients with endophthalmitis revealed Gram-positive microflora in 100 % of cases. There were also significant differences between the groups in the intravitreal, systemic and subconjunctival antibiotic therapy used.Conclusion. Patients with penetrating eye injury and foreign body, complicated by endophthalmitis, are characterized by more signs of inflammation, pronounced damage to the eye and its structures.

Panophthalmitis After Aurolab Aqueous Drainage Implant (AADI) in Refractory Glaucoma with Vogt-Koyanagi-Harada Syndrome (VKH): A Case Report

This case of Vogt-Koyanagi-Harada (VKH) disease underwent Aurolab Aqueous Drainage Implant (AADI) for refractory glaucoma. Later, developed postoperative (2 months) panophthalmitis characterized by sudden visual loss, moderate pain, redness, and purulent discharge. Systemic, topical, and intravitreal antibiotic therapy was started immediately, and evisceration was performed.

Commentary: Is it time to re-evaluate the empiric intravitreal antibiotic therapy in infectious bacterial endophthalmitis?

Commentary: Is it time to re-evaluate the empiric intravitreal antibiotic therapy in infectious bacterial endophthalmitis?

Panophthalmitis After Aurolab Aqueous Drainage Implant (AADI) in Refractory Glaucoma with Vogt-Koyanagi-Harada Syndrome (VKH): A Case Report

This case of Vogt-Koyanagi-Harada (VKH) disease underwent Aurolab Aqueous Drainage Implant (AADI) for refractory glaucoma. Later, developed postoperative (2 months) panophthalmitis characterized by sudden visual loss, moderate pain, redness, and purulent discharge. Systemic, topical, and intravitreal antibiotic therapy was started immediately, and evisceration was performed.

Infectious endophthalmitis at a Philippine tertiary hospital: a ten-year retrospective study

BackgroundEndophthalmitis is a sight-threatening disease characterized by marked progressive inflammation of the vitreous and/or aqueous humors. Limited information is currently available regarding endophthalmitis in the Philippines. This study aimed to provide long-term summary data on endophthalmitis cases seen at the largest tertiary referral hospital in the Philippines.MethodsAll endophthalmitis cases diagnosed at the Philippine General Hospital from January 1, 2007 to December 31, 2016 were retrieved and classified by etiology. Data pertaining to history, associated risk factors, isolated microorganisms, management, and final visual outcomes for each patient were reviewed.ResultsA total of 202 cases diagnosed within the audit period were included in the study. These were classified as post-traumatic (55.94%), endogenous (14.36%), acute post-operative (10.40%), keratitis-induced (6.93%), chronic post-operative (5.44%), bleb-associated (3.96%), and suture-associated (2.97%) endophthalmitis. Males comprised 71.29% of the population, while the largest age group affected was 0–10 years (24.75%). The culture-positive rate was 57.89%. The predominant etiology was Gram-positive bacteria (38.18%), followed by Gram-negative bacteria and mixed pathogens (21.82% each), and fungi (18.18%). The most common organisms were Streptococcus, Staphylococcus, Pseudomonas, Aspergillus, and Candida, accounting for 56.45% of isolates. Pars plana vitrectomy was done for 62.87% of patients, intravitreal and other antibiotic therapy in 23.27%, and primary enucleation/evisceration in 10.89%. The final outcomes and best corrected visual acuities were: anophthalmia 11.86%, no light perception/no dazzle 27.84%, light perception 8.76%, hand motions 24.23%, counting fingers 5.15%, 3/200 to 20/50 12.89%, and 20/40 to 20/20 9.28%.ConclusionsThere was a higher proportion of post-traumatic endophthalmitis cases compared to traditional estimates but consistent with studies from China and Thailand. The majority of these cases involved younger children as well as young to middle-aged males engaged in carpentry and construction work, implying a need for increased public health awareness and strengthening of childcare and workplace safety policies. Our microbiologic profile showed a lower proportion of Gram-positive infections and a higher proportion of mixed pathogen infections compared to other studies. There was also a higher proportion of fungi associated with post-operative and keratitis-induced endophthalmitis. The best outcomes were seen in acute post-operative and bleb-associated endophthalmitis, and the worst outcomes in endogenous and keratitis-induced endophthalmitis. Visual outcomes were poorer compared to other Western and Asian countries, with only 21.7% of patients improving from presentation.

2510 Bacteremia With Liver Abscess and Endophthalmitis: A Rare Case of Invasive Klebsiella Pneumoniae Syndrome

INTRODUCTION: Pyogenic liver abscesses are often polymicrobial with Escherichia coli being the most common isolated organism. Klebsiella pneumoniae is a rare cause of pyogenic liver abscesses and often affects patients with immunodeficient states. Here we discuss a rare case of primary Klebsiella pneumoniae liver abscess with subsequent metastatic infection leading to vision loss. CASE DESCRIPTION/METHODS: A 68-year-old African American woman presented with complaints of intermittent fever, chills, right upper quadrant abdominal pain and blurry vision of the left eye. Her past medical history was notable for recent laparoscopic hernia repair, cataract surgery, and hypertension. The abdominal exam showed moderate tenderness of the right upper quadrant; ophthalmic exam of the left eye revealed afferent pupillary defect and decreased visual acuity. Labs were notable for leukocytosis, total bilirubin of 2.7, AST of 161, ALT of 135 and an alkaline phosphatase of 110. CT abdominal imaging revealed an abscess within the dome of the right liver measuring 5.2 × 6.3 × 4.1 cm. She was admitted to the intensive care unit and started on broad-spectrum empiric antibiotic therapy. Blood culture revealed gram-negative rods. B-scan ultrasonography of the left eye showed vitritis with loculation confirming the diagnosis of endophthalmitis. Intravitreal antibiotics were promptly administrated. She underwent CT guided sampling and drainage of the hepatic abscess with fluid culture growing the same organism identified in the blood cultures: mucoid Klebsiella pneumoniae complex. The patient was diagnosed with invasive Klebsiella bacteremia, liver abscess, and endophthalmitis and developed permanent vision loss in the left eye despite prompt intravenous and intravitreal antibiotic therapy. DISCUSSION: Klebsiella pneumoniae invasive liver abscess syndrome is a rare condition in the United States making timely diagnosis and treatment a challenge per se. Known risk factors for invasive liver abscess syndrome include diabetes mellitus, hepatobiliary disease, alcoholism, chronic renal failure, and cancer. While our patient did not have any of these specific comorbidities and had no recent international travel, her age, and recent surgical interventions likely predisposed her to an immunocompromised state. Invasive liver abscess syndrome can be fatal with poor prognosis if treatment is delayed. Timely abscess drainage and administration of intravenous antibiotics is crucial and should be implemented early on in the clinical course.

Endophthalmitis Related With Infectious Uveitis: Clinic, Diagnosis, Treatment

Metastatic endogenous endophthalmitis is a rare but serious ocular infection by seeding of bacteria or fungi into the eye from a source elsewhere in the body. Studies suggest that endogenous endophthalmitis accounts for 2 to 8% of all endophthalmitis. In North America and Europa, the most identified causative bacteria are Staphylococcus aureus and Streptococcus pneumonia, while in East Asia, Klebsiella pneumonia is chiefly responsible. Among fungal etiologies; Candida albicans is the most common yeast, and Aspergillus is the most common mold. Major risk factors are immunocompromised states (for example, chronic corticosteroid use, malignancy, end-stage liver / renal disease, organ transplant, diabetes mellitus), intravenous drug use and indwelling catheter. A key diagnostic finding is the presence of white infiltrate originating in the choroid and sometimes erupting in the vitreous cavity. The fundus may be obscured because of vitreous haze or vitritis. Patients' presentation and history are important in diagnosis. Depending on the suspected primary locus of infection, blood, urine, and other cultures are done. Also, a vitreous tap must be obtained. Hospitalization, infectious disease consultation, systemic therapy with antibiotics or antifungals should be started. Then, aggressive intravitreal antibiotic therapy, with or without pars plana vitrectomy, should be added to the regiment Early diagnosis is crucial because of delay of treatment is the factor most associated with poor visual prognosis.

Infectious Sources, Prognostic Factors, and Visual Outcomes of Endogenous Klebsiella pneumoniae Endophthalmitis

To investigate the infectious sources and prognostic factors for poor visual outcome, including subjective symptoms, presenting clinical features, laboratory data, and treatments, in patients diagnosed with endogenous Klebsiella pneumoniae endophthalmitis (EKE) at a tertiary referral center in Northern Taiwan. Retrospective, single-institution, consecutive case series. One hundred ten consecutive patients (124 eyes) diagnosed with EKE. One hundred ten patients (124 eyes) were reviewed retrospectively between January 1996 and April2013. Visual acuity (VA), subjective symptoms, presenting clinical features, laboratory data, treatments, and requirement of evisceration or enucleation. Of the 110 patients with EKE, 74 (67.3%) were men. Diabetes was the most commonly associated systemic disease (75/110 [68.2%]), and liver abscess was the major infection source (85/110 [77.3%]). In addition, 91 of 124 eyes (73.4%) had final VA worse than counting fingers (CF; poor visual outcome), and 20 eyes required evisceration or enucleation. The binary multivariate logistic regression (forward-Wald) model revealed that poor initial VA worse than CF (odds ratio [OR], 8.8; 95% confidence interval [CI], 2.2-36; P= 0.002), positive vitreous culture results (OR, 9.8; 95% CI, 1.7-56.1; P= 0.010), posterior focal EKE (OR, 0.15; 95% CI, 0.03-0.8; P= 0.027), and the presence of intravitreal dexamethasone administration (OR, 0.19; 95% CI, 0.04-0.9; P= 0.030) were the significant independent factors for visual outcomes. Liver abscess was the major infection source, and EKE typically has poor visual prognosis. Early diagnosis and prompt treatment may salvage useful vision in some eyes. Early diagnosis with fair initial VA and intravitreal antibiotic and dexamethasone combination therapy may have beneficial effects on visual outcomes.

Diagnostic performance of blood culture bottles for vitreous culture compared to conventional microbiological cultures in patients with suspected endophthalmitis.

The purpose of this investigation was to evaluate the performance of blood culture bottles in comparison to conventional microbiological culture techniques in detecting causative microorganisms of endophthalmitis and to determine their anti-infective susceptibility profiles. All consecutive cases with clinically suspected endophthalmitis in a university-based ophthalmology department between January 2009 and December 2016 were analysed in this retrospective comparative case series. Samples from 247 patients with suspected endophthalmitis underwent microbiological diagnostic work-up. All three culture methods were performed from 140 vitreous specimens. Vitreous fluid specimens were inoculated in blood culture bottles, aerobic and anaerobic broth solutions, and on solid media. Anti-infective susceptibility profiles were evaluated by semi-automated methods and/or gradient diffusion methods. Microorganisms were grown in 82 of 140 specimens for which all methods were performed (59%). Microorganisms were more frequently grown from blood culture bottles (55%) compared to broth solution (45%, p = 0.007) and solid media (33%, p < 0.0001). Considerable differences in the performance among culture media were detected for fungal pathogens. All grown fungi were detected by blood culture bottles (11 of 11, 100%). Broth solution recovered 64% and solid media 46% of grown fungi. No Gram-positive bacterium was resistant to vancomycin and all Gram-negative pathogens except for one isolate were susceptible to third-generation cephalosporins. In suspected endophthalmitis patients, blood culture bottles have a higher overall pathogen detection rate from vitreous fluid compared to conventional microbiological media, especially for fungi. The initial intravitreal antibiotic therapy with vancomycin plus third-generation cephalosporins appears to be an appropriate treatment approach for bacterial endophthalmitis.

Salmonella Typhi Associated Endogenous Endophthalmitis: A Case Report and a Review of Literature

ABSTRACTAim: To report a rare case of Salmonella typhi associated endogenous endophthalmitis in an immunocompetent male and to review the available literature.Methods: Retrospective chart review.Results: A 28-year-old immunocompetent male presented with a 3-day-old history of pain, redness and diminished vision in his left eye. Conjunctival chemosis, corneal haze, and hypopyon were noted and yellowish exudates filled the vitreous cavity. A detailed elicitation of history revealed that patient had been treated for enteric fever that presented with diarrhea and fever, two weeks prior to current presentation. Blood and vitreous cultures grew Gram negative bacilli, identified as S. typhi. Despite intensive intravitreal and systemic antibiotic therapy, an evisceration had to be performed.Conclusions: Endogenous endophthalmitis can be one of the rare sequelae of enteric fever and may present in the acute and relapsing phases and often times have a rapidly fulminant course with poor visual outcomes.

Intravenous Drug Use–Associated Endophthalmitis

To characterize features and outcomes of intravenous drug use (IVDU)-associated endophthalmitis. Retrospective cross-sectional study. A retrospective chart review of all cases of endophthalmitis seen between September 2006 and November 2014 at a single academic referral center was performed. All cases of IVDU-associated endophthalmitis were identified and characterized. Ophthalmic examination findings, microbial results, visual outcomes, and secondary ocular sequelae. Thirty patients (32 eyes) with IVDU-associated endophthalmitis were identified, which represented 9% of all endophthalmitis patients (n= 338) and 44% of all endogenous endophthalmitis patients (n= 68). Mean follow-up was 11 months. All eyes had vitritis, 6 had hypopyon, and 2 had subretinal abscesses. Twenty eyes had macular involvement, 8 eyes had no macular involvement, and media opacities precluded macular assessment in 4 eyes. Initial treatment was needle vitreous biopsy with intravitreal antibiotics ("tap and inject") in 25 eyes (78%) and pars plana vitrectomy (PPV) in 6 eyes (19%); 1 patient refused ocular treatment. An organism was identified from at least 1 source in 75% of eyes (24/32): 59% fungal, 16% bacterial, 22% negative cultures, and 3% refused ocular cultures. Mean visual acuity improved significantly between initial examination and final follow-up (1.64 logMAR to 0.91 logMAR, P < 0.0001). At final follow-up, 90% of eyes had improved vision compared with presentation, 31% of eyes had 20/40 or better vision, and 25% of eyes had 20/200 or worse vision. Twenty-one eyes (66%) required PPV for their infection-6 initially and 15 secondarily after tap and inject. Sixty-nine percent of eyes (9/13) that had cultures sent from a secondary PPV had positive cultures, despite almost all receiving appropriate intravitreal antibiotic therapy at the time of the tap and inject. Eight patients (27%) had extraocular signs of infection. Twenty eyes (63%) suffered secondary ocular sequelae. This represents the largest series of IVDU-associated endophthalmitis. Bacterial etiologies constitute an important share of cases. A majority of patients eventually required PPV and there was frequent culture positivity even after tap and inject with appropriate antibiotics; therefore, early PPV may have an important role in management.

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Introduction: Introduction End organ dysfunction related to infective endocarditis (IE) is a common cause for the referral to the intensive care unit. A thorough history and physical examination remains an integral part of management of patients with IE. Intensivists should maintain a high index of suspicion towards detecting rare manifestations of IE. We present a case of Methicillin sensitive Staphylococcus aureus (MSSA) endocarditis with two such rare complications in the form of bilateral endophthalmitis and parotitis which were diagnosed early and treated promptly. Case presentation A 63 year old male with a past history of mitral valve annuloplasty was hospitalized for fever with rigors of four day duration. His admission vitals were notable for fever (103 F), tachycardia and tachypnea. Physical examination revealed an apical holosystolic murmur and painful erythematous finger nodules (Osler's nodes).Pertinent positive labs included thrombocytopenia (count of 40,000), elevated BUN (60) and creatinine (1.7). Appropriate antibiotics were initiated for concern of IE; blood cultures grew Methicillin sensitive Staphylococcus aureus (MSSA) and subsequent work up with Trans-esophageal echocardiography showed mitral valve vegetation's (> 2 cm) on the anterior leaflet of the mitral valve with concomitant severe mitral regurgitation. Hospital course was complicated by the development of sudden painful bilateral parotid gland enlargement, bilateral decreased visual acuity and confusion. A thorough visual, neck and neurological exam revealed findings of bilateral endophthalmitis which was emergently treated with vitreous aspiration and intravitreal antibiotic instillation leading to an improvement in vision. Vitreal fluid cultures were positive for MSSA. Bilateral Parotid gland enlargement- acute parotitis secondary to disseminated sepsis was successfully treated with antibiotics and hydration. MRI of brain revealed multiple small cerebral infarcts and small areas of intracerebral hemorrhage consistent with septic infarcts and secondary hemorrhagic conversion. While the risks and benefits of emergent mitral valve replacement surgery were being contemplated, unfortunately only four days into the hospital course patient suffered a massive intracerebral hemorrhage and passed away. Discussion The pathogenesis for complications in IE includes embolic, local spread of infection, metastatic infection or immune-mediated damage. Embolization remains a distressingly common complication of IE and can occur even after appropriate therapy. Endogenous endophthalmitis is a rare complication of infective endocarditis that occurs due to direct invasion of ocular tissues (septic emboli) or by changes in vascular endothelium caused by substrates released during infection. The most common cause of the infection is Staphylococcus aureus. Endogenous endophthalmitis due to MSSA infective endocarditis is an extremely rare complication. Intravitreal and systemic antibiotic therapy should be initiated promptly. Acute bilateral parotitis is rare and is associated with mumps and connective tissue disorders; while in our case it seems to be secondary to MSSA bacteremia and septic emboli. Bilateral Endophthalmitis and Parotitis are very rare complications of infective endocarditis with only a few case reports published to date. Our patient is the first case in literature where both manifestations occurred together as a part of embolic phenomenon. Most common pathogen implicated in the setting of endocarditis is Staphylococcus aureus. Conclusion: Infective endocarditis (IE) is associated with a myriad of complications. It is important to recognize rare complications of IE like bilateral endophthalmitis and parotitis and act rapidly to prevent morbidity associated with it.

Quinupristin/dalfopristin in Staphylococcus aureus endophthalmitis: a case report

IntroductionThe intravitreal injection of antibiotics remains the mainstay of therapy for postoperative endophthalmitis. Bacterial resistance, however, is still a pitfall in achieving an adequate response to treatment. Quinupristin/dalfopristin might be a feasible therapeutic option in these cases.Case presentationA 55-year-old Hispanic man had endophthalmitis secondary to Staphylococcus aureus in his right eye and was treated with intravitreal 0.4 mg/0.1 ml quinupristin/dalfopristin injection. Inflammation and pain remission were observed at four days after injection. The final best-corrected visual acuity was 20/40.ConclusionAlthough vancomycin remains the first-line intravitreal antibiotic therapy against infectious endophthalmitis caused by Gram-positive bacteria, quinupristin/dalfopristin exhibits similar efficacy and is theoretically more active against vancomycin-resistant strains, with no apparent retinal toxicity.

Endophthalmitis: Pathogenesis, clinical presentation, management, and perspectives.

Endophthalmitis is a rare but sight-threatening complication that can occur after ocular surgery or trauma or as a consequence of systemic infection. To optimize visual outcome, early diagnosis and treatment are essential. Over recent decades, advances in hygienic standards, improved microbiologic and surgical techniques, development of powerful antimicrobial drugs, and the introduction of intravitreal antibiotic therapy have led to a decreased incidence and improved management of endophthalmitis. However, endophthalmitis still represents a serious clinical problem. This review focuses on current principles and techniques for evaluation and treatment of endophthalmitis. In addition, it addresses recent developments regarding antimicrobial treatment and prophylaxis of infectious endophthalmitis.

Endophthalmitis following open globe injury

Objective:To study the clinical characteristics of post-traumatic endophthalmitis following open-globe injury and identify factors affecting its frequency in order to gain further knowledge about possible risk factors for the development...

The Efficacy of Intravitreal Gatifloxacin in Experimental S. epidermidis Endophthalmitis

Purpose: To compare the efficacy of intravitreal gatifloxacin with intravitreal vancomycin in the treatment of Staphylococcus epidermidis endophthalmitis in a rabbit model. Methods: Albino rabbits (n=30), infected with an intravitreal inoculum of S. epidermidis (105 colony forming unit/0.1 mL), were divided into 6 groups (n=5). Groups I and IV received 200 μg/0.1 mL of intravitreal gatifloxacin, and groups II and V were injected 1000 μg/0.1 mL of vancomycin intravitreally. Intravitreal balanced salt solutions (untreated control) were given to Groups III and VI. Intravitreal antibiotic therapy commenced 24 hours after bacterial inoculation. The bactericidal efficacy was determined by electroretinography (ERG), clinical grading, bacterial culture of vitreous aspirates and histopathologic grading. ERGs and clinical gradings were performed only for groups I, II, and III and bacterial cultures were done only for groups IV, V, and VI. Results: Eyes in the gatifloxacin groups showed similar appearance to those in the vancomycin treated groups clinically, histologically, and functionally as proved with ERG. All aspirates from the gatifloxacin and vancomycin groups were culture‐negative at 5 days after bacterial inoculation, whereas all eyes in the untreated control group were culture‐positive. Conclusions: This study demonstrated that intravitreal injection of 200 μg /0.1mL gatifloxacin appeared to be equally effective compared to intravitreal 1000 μg /0.1 mL vancomycin in the treatment of S. epidermidis endophthalmitis. If proven safe and efficacious after further study in humans, intravitreal injection of gatifloxacin could be considered an effective alternative to vancomycin for the treatment of S. epidermidis endophthalmitis.

Endogenous Klebsiella Endophthalmitis Associated with Pyogenic Liver Abscess

To study risk factors, clinical features, treatment, and visual outcomes in patients with endogenous Klebsiella pneumoniae endophthalmitis (EKE) associated with K. pneumoniae-induced pyogenic liver abscess, and to investigate contributing factors in successfully treated cases. Retrospective, noncomparative, interventional case series. Review of medical records of 22 consecutive patients with EKE and pyogenic liver abscess. The affected eyes of 22 consecutive patients (n = 27) with EKE, who presented to our ophthalmic service during a recent 8-year period, were studied retrospectively. Best-corrected visual acuity (VA) at end of follow up. Diabetes mellitus was the most common comorbid risk factor (n = 15 [68%]). Five patients (23%) had bilateral eye involvement. On initial presentation, characteristic pupillary hypopyon was observed in 12 eyes. Diagnosis was confirmed by blood culture in 8 patients, culture of liver aspirate in 17 patients, and vitreous culture in 11 patients. Other associated septic metastatic lesions included pulmonary abscess or emboli in 6 cases, brain abscess or meningitis in 3 cases, and prostate and kidney abscesses in 1 case. Despite aggressive intravenous and intravitreal antibiotic therapy, final VA of light perception or worse affected 24 eyes (89%), of which 11 (41%) were eventually eviscerated or enucleated. Successful treatment with retained useful vision better than 6/60 was achieved in 3 eyes, of which 2 received early intravitreal corticosteroid injections. However, the other remaining eye had a focal subretinal abscess. Physicians should be alert to the development of EKE when patients with diabetes along with K. pneumoniae-induced pyogenic liver abscess complain of ocular symptoms. In the majority of patients with EKE associated with pyogenic liver abscess, visual outcome is generally poor despite aggressive antibiotic therapy. Early diagnosis and prompt intervention with intravitreal antibiotics within 48 hours may salvage useful vision in some patients with EKE.

58-Year-Old Man With Fever and Right Eye Pain

58-Year-Old Man With Fever and Right Eye Pain