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Keywords:

  • bacterial eye infections;
  • endophthalmitis;
  • intravitreal injection;
  • methicillin-resistant Staphylococcus aureus

Abstract

Background:  There are currently no standardized treatment guidelines for endogenous bacterial endophthalmitis. We report the long-term outcomes of early intravitreal treatment of endogenous bacterial endophthalmitis, defined as intravitreal and systemic antibiotics administered within 24 h of diagnosis, with conservative use of pars plana vitrectomy.

Design:  Interventional retrospective case series.

Participants:  Consecutive patients treated for culture-proven endogenous bacterial endophthalmitis between 2001 and 2008 at the Weill Cornell Medical Center.

Methods:  The clinical records of 18 eyes from 13 patients were reviewed.

Main Outcome Measures:  Visual acuity.

Results:  Mean age at presentation was 61 (25–85) years. All patients had underlying medical conditions. Extraocular infectious foci were identified in nine (69%) patients, with endocarditis being the most common. Gram-positive organisms were identified in 12 (92%) patients, including five with methicillin-resistant Staphylococcus aureus. No cases were misdiagnosed. Final visual acuities of better than 6/120 and counting fingers were achieved in 6 (55%) and 7 (64%) of 11 eyes, respectively. Longer time between onset of ocular symptoms and intravitreal antibiotic injection correlated with worse visual outcomes (P < 0.05) and was associated with mortality (P < 0.05). Mortality was also associated with methicillin-resistant S. aureus infection (P < 0.05). Of those with follow up longer than 1 year, retinal detachment developed in 3 of 10 eyes (30%) after the acute infection, and cataract developed in 6 of 9 (67%) phakic eyes. Mean follow up was 146 (4–313) weeks.

Conclusions:  Intravitreal antibiotics for endogenous bacterial endophthalmitis administered within 24 h to supplement immediate systemic antibiotics may provide a relatively favourable visual prognosis.