Early intravitreal treatment of endogenous bacterial endophthalmitis
Article first published online: 21 APR 2011
© 2011 The Authors. Clinical and Experimental Ophthalmology © 2011 Royal Australian and New Zealand College of Ophthalmologists
Clinical & Experimental Ophthalmology
Volume 39, Issue 8, pages 771–778, November 2011
How to Cite
Yonekawa, Y., Chan, R. P., Reddy, A. K., Pieroni, C. G., Lee, T. C. and Lee, S. (2011), Early intravitreal treatment of endogenous bacterial endophthalmitis. Clinical & Experimental Ophthalmology, 39: 771–778. doi: 10.1111/j.1442-9071.2011.02545.x
- Issue published online: 3 NOV 2011
- Article first published online: 21 APR 2011
- Accepted manuscript online: 1 MAR 2011 06:07AM EST
- Received 10 October 2010; accepted 16 February 2011.
- bacterial eye infections;
- intravitreal injection;
- methicillin-resistant Staphylococcus aureus
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.