Endophthalmitis caused by Enterococcus faecalis: a case series.
BACKGROUND
To profile the etiology, clinical features, visual and anatomical outcomes in eyes diagnosed with Enterococcus faecalis endophthalmitis.


METHODS
A single (tertiary care) center, Retrospective interventional case series. Clinical and microbiological records of 26 consecutive eyes with culture positive E. faecalis endophthalmitis treated at a tertiary referral ophthalmic hospital in south India from 1st January 1995 to September 2007 were reviewed and analyzed.


RESULTS
Of the twenty-six eyes, 12 were of postsurgical etiology, 11 cases were posttraumatic while 3 were of endogenous causes. Two eyes had an intraocular foreign body. Initial mean visual acuity was 3.19 logMAR (range: 0.77-4). All cases were treated with vitrectomy and intravitreal injections. Six cases developed retinal detachment after initial surgery, but only 30.7% eyes had a poor anatomical outcome (8 patients out of 26). All cases except one were sensitive to Vancomycin. Final mean visual acuity was 2.12 logMAR (range: 0.17-4). Paired 't' test showed statistically significant (P = 0.008) good visual outcome (better than or equal to 3/60).


CONCLUSIONS
Surgery (12 of 26 eyes) and trauma (11 of 26 eyes) were the commonest causes of E. faecalis endophthalmitis. Our results indicate that early surgical intervention can lead to a good functional outcome despite the virulent nature of the organism. Since almost all the cases were sensitive to Vancomycin, it may be considered as a first line drug in the management of such eyes.
Rishi
Ekta
E
Shri Bhagwan Mahavir Vitreoretinal Services, Medical Research Foundation, Sankara Nethralaya, Chennai, India. docrishi@yahoo.co.in
Rishi
Pukhraj
P
Nandi
Krishnendu
K
Shroff
Daraius
D
Therese
K Lily
KL
D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D009877:Endophthalmitis / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D013293:Enterococcus faecalis / Q000302:isolation & purification*; D015818:Eye Infections, Bacterial / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D012189:Retrospective Studies; D014640:Vancomycin / Q000627:therapeutic use; D014792:Visual Acuity; D014821:Vitrectomy
D000900:Anti-Bacterial Agents; D014640:Vancomycin