title: Early intravitreal treatment of endogenous bacterial endophthalmitis.
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.
  
  
  METHODS
  Interventional retrospective case series.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
authors: Retina Service, Department of Ophthalmology, NewYork-Presbyterian Hospital, Weill Cornell Medical College, New York, New York 10021, USA.
authors: Yoshihiro
authors: Y
authors: Yonekawa
authors: R V Paul
authors: RV
authors: Chan
authors: Ashok K
authors: AK
authors: Reddy
authors: Cristiana G
authors: CG
authors: Pieroni
authors: Thomas C
authors: TC
authors: Lee
authors: Sangwoo
authors: S
authors: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D009877:Endophthalmitis / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D015818:Eye Infections, Bacterial / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D058449:Intravitreal Injections; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014792:Visual Acuity
chemical_list: D000900:Anti-Bacterial Agents