title: Culture-proven endogenous endophthalmitis: clinical features and visual acuity outcomes.
abstract: OBJECTIVE
  To investigate clinical features and visual acuity outcomes associated with endogenous endophthalmitis.
  
  
  METHODS
  Retrospective, observational case series.
  
  
  METHODS
  Twenty-one eyes of 21 patients treated at Bascom Palmer Eye Institute for culture-proven endogenous endophthalmitis between 1996 and 2002 were reviewed.
  
  
  RESULTS
  Patients were followed a mean of 3 months (range, 1 to 12 months). Fungal isolates occurred in 13 eyes (62%), gram-positive isolates in 7 (33%), and gram-negative isolates in 1 (5%). Twelve patients (57%) were hospitalized at the time of diagnosis and 6 patients (29%) died within 2 months of diagnosis. Initial treatment included tap and injection of intravitreal medication in 10 eyes (48%) and pars plana vitrectomy with injection of intravitreal medication in 11 eyes (52%). Final visual outcomes were obtainable for 18 eyes (two patients died within 10 days of diagnosis, and one patient was lost to follow-up). Eight (44%) of these 18 eyes achieved a visual acuity of 20/400 or better and 10 (56%) of 18 eyes achieved a visual acuity worse than 20/400, including 3 that were either enucleated or eviscerated. Three eyes with Aspergillus endophthalmitis had worse visual outcomes than eyes with either Candida (P =.036) or bacterial endophthalmitis (P =.024).
  
  
  CONCLUSIONS
  Compared with published series of postoperative or post-traumatic endophthalmitis, patients with endogenous endophthalmitis are more likely to have fungal isolates with a predominance of Candida albicans. Endogenous endophthalmitis is generally associated with high mortality and poor visual acuity outcomes, particularly when caused by more virulent species such as Aspergillus.
authors.affiliation: Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami School of Medicine, Miami, Florida 33101, USA.
authors.forename: Vivian
authors.initials: V
authors.lastname: Schiedler
authors.forename: Ingrid U
authors.initials: IU
authors.lastname: Scott
authors.forename: Harry W
authors.initials: HW
authors.lastname: Flynn
authors.forename: Janet L
authors.initials: JL
authors.lastname: Davis
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Benz
authors.forename: Darlene
authors.initials: D
authors.lastname: Miller
mesh_terms: D000328:Adult; D000368:Aged; D000890:Anti-Infective Agents / Q000627:therapeutic use; D001419:Bacteria / Q000302:isolation & purification; D009877:Endophthalmitis / Q000175:diagnosis* / Q000382:microbiology* / Q000628:therapy; D015818:Eye Infections, Bacterial / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy; D015821:Eye Infections, Fungal / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy; D005260:Female; D005658:Fungi / Q000302:isolation & purification; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology*; D014821:Vitrectomy
chemical_list: D000890:Anti-Infective Agents