Endogenous endophthalmitis: 10-year experience at a tertiary referral centre.
OBJECTIVE
Endogenous endophthalmitis (EE) is a sight-threatening emergency and the aetiology is often multifactorial. Delayed diagnosis may exacerbate the poor visual prognosis. We describe the management and visual outcomes of EE presenting to a tertiary referral centre.


METHODS
A prospective consecutive case series of 64 patients presenting with presumed EE from 1997 to 2007 to the Royal Victorian Eye and Ear Hospital were included. All data were collected in a standardized manner. Outcome measures included: visual acuity, microbial profiles, and vitrectomy rate.


RESULTS
In total, 64 cases of EE were identified over the study period with a mean age of 57.5 years, and 53.5% were male. Presenting acuities ranged from Snellen 6/6 to no perception of light (NPL). Identifiable risk factors were present in 78.1%, with the majority related to intravenous drug abuse. A 64.1% culture positivity rate was recorded. A vitrectomy rate of 57, 56, and 21% was recorded in documented bacterial, fungal, and no growth cases, respectively. Final Snellen acuities ranged from 6/6 to NPL. A total of 5 out of 64 eyes were enucleated, of which 3 identified Klebsiella species. Better visual outcome was documented in fungal cases.


CONCLUSIONS
EE is a serious ocular condition and has a varied aetiology. Visual outcomes are often poor, irrespective of the method of management. Fungal aetiology often confers a better prognosis, and vitrectomy is advocated for bacterial proven cases.
Centre for Eye Research Australia, The Royal Victorian Eye and Ear Hospital, University of Melbourne, East Melbourne, VIC, Australia. drpaulconnell@gmail.com
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Connell
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O'Neill
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Fabinyi
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Islam
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Buttery
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McCombe
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Essex
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Roufail
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Clark
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Chiu
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Campbell
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Allen
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D001419:Bacteria / Q000302:isolation & purification; D009877:Endophthalmitis / Q000382:microbiology / Q000503:physiopathology / Q000628:therapy; D015818:Eye Infections, Bacterial; D005260:Female; D005658:Fungi / Q000302:isolation & purification; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D014792:Visual Acuity; D014821:Vitrectomy / Q000706:statistics & numerical data; D055815:Young Adult