Prognostic Factors in Patients With Endogenous Endophthalmitis

Jeong Ho Hwang; Nam Chun Cho

doi:10.3341/jkos.2009.50.6.858

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Hwang and Cho: Prognostic Factors in Patients With Endogenous Endophthalmitis

Original Article

J Korean Ophthalmol Soc 2009;50(6):858-863.

Published online: 7 September 2009

DOI: https://doi.org/10.3341/jkos.2009.50.6.858

Prognostic Factors in Patients With Endogenous Endophthalmitis

Jeong Ho Hwang, MD, Nam Chun Cho, MD

Department of Ophthalmology, Chonbuk National University Medical School, Jeonju, Korea

Address reprint requests to Nam Chun Cho, MD Department of Ophthalmology, Chonbuk National University, College of Medicine #634-18 Geumam-dong, Dukjin-gu, Jeonju 561-712, Korea Tel: 82-63-250-2477, Fax: 82-63-250-1960, E-mail: cnauo@moak.chonbuk.ac.kr

Received 25 August 2008 Accepted 3 March 2009

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

We evaluated the causative microorganisms, dispositions, and visual prognosis of endogenous endophthalmitis.

Methods

The records of 12 eyes of 10 patients who were diagnosed with endogenous endophthalmitis were retrospectively reviewed with respect to the causative microorganisms, dispositions, visual prognosis, initial visual acuity, time interval between onset of symptom, and the course of treatment.

Results

Three of the four eyes infected with a candida species recovered a visual acuity of 0.1 or better; none of the other infected eyes reached higher than 0.1 (p=0.024). Initial visual acuity of less than hand movement reached globe loss in three eyes, while 5 eyes with initial visual acuity of better than hand movement of seven eyes did not lose the globe (p=0.045). Three out of patients with a time interval between onset of symptoms and treatment of more than five days did not lose the globe, while those with a time interval of less than five days of eight eyes did not lose the globe.

Conclusions

Visual prognosis and globe survival depends mainly on the underlying microorganism, initial visual acuity, the time interval between the onset of symptom, and treatment. Patients with candida endophthalmitis had good visual outcome compared with the others, and thus microbial culture identification is a useful predictor of visual acuity and treatment.

Keywords: Endogenous endopthalmitis, Globe survival, Microorganism, Visual acuity

References

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Figure 1.

Causative microorganisms in vitreous, blood culture.

Table 1.

Clinical summary

Case	Eye	Age/G	Organism	Risk factor	Initial V/A	Culture	Time (day)	IVT agent V	itrectomy	Final V/s
1	OD	51/M	S. aureus	DM	CF	V^*	4	Va^‡, Ak^§	N	CF
	OS	51/M	S. aureus	DM	0.2	V^*	4	Va^‡, Ak^§	N	0.02
2	OS	91/F	None	Laryngeal ca′	LP	None	7	Va^‡, Ak^§	N	Evi^#
3	OS	62/F	S. pneumoniae	None	LP	V^*	10	Va^‡, Ak^§	N	Evi^#
4	OS	95/F	P. aeruginosa	None	NLP	V^*	8	Va^‡, Ak^§	N	Evi^#
5	OS	45/M	K. pneumoniae	DM, Liver cirrhosis, pneumoniae	0.08	B^†	4	Va^‡, C^Π, Amp	N	LP
6	OD	69/M	C. albicans	Multiple myeloma	CF	V^*	7	Va^‡, Ak^§, Amp	Y	0.08
7	OD	39/M	C. albicans	Abdominal surgery	0.3	V^*, B^†	3	Va^‡, Ak^§, Amp	Y	0.6
8	OS	47/M	S. aureus	DM	HM	V^*	3	Va^‡, Ak^§	Y	HM
9	OS	46/M	S. viridans	DM	HM	V^*	4	Va^‡, Ak^§	Y	HM
10	OD	58/M	C. albicans	DM, Liver abscess	0.04	V^*, B^†	2	Va^‡, Ak^§, Amp	Y	0.4
	OS	58/M	C. albicans	DM, Liver abscess	0.15	V^*, B^†	2	Va^‡, C^Π, Amp	Y	0.1

^* V=Vitreous sample

^† B=blood sample

^‡ Va=vancomycin

^§ Ak=amikacin

^Π C=ceftazidime

^# Evi=evisceration.

Table 2.

Predisposing medical conditions

Predisposing medical condition	N^*
Diabetes	7
Liver abscess	3
Cancer	1
Hematologic malignancies	1
Recent severe surgical procedure	1
Pneumonia	1
None	2

^* N=patient number.

Table 3.

Outcome in eyes infected with candida and those infected with other microorganisms

Microorganism	Globe loss	≤0.02	≥0.1
Candida species	0/4	0/4	3/4
Others	2/7	5/7	0/7
Staphylococcus species	0/3	3/3	0/3
Streptococcus species	1/2	1/2	0/2
Pseudomonas aeruginosa	1/1	0/1	0/1
Klebsiella pneumoniae	0/1	1/1	0/1
p-value^*	0.491	0.061	0.024^†

^* p-value was calculated by chi-square test

^† p-value <0.05.

Table 4.

Outcome in eyes with initial V/A

Initial V/A	Globe loss	≤0.02	≥0.1
≤ HM	3/5	2/5	0/5
> HM	0/7	3/7	3/7
p-value^*	0.045^†	1.0	0.2

^* p-value was calculated by chi-square test

^† p-value <0.05

Table 5.

Outcome in eyes with time^*

Times^*	Globe loss	≤0.02	≥0.1
≤5 days	0/8	5/8	3/8
>5 days	3/4	0/4	0/4
p-value^†	0.017^‡	0.082	0.4

^* Times=time interval between onset of symptom and treatment

^† p value was calculated by chi-square test

^‡ p value<0.05.

Table 6.

Outcome in vitrectomy eyes and non-vitrectomy eyes

Operation	Globe loss	≤0.02	≥0.1
Vitrectomy eyes	0/6	2/6	3/6
Non-vitrectomy eyes	3/6	3/6	0/6
p-value^*	0.18	1.0	0.18

^* p-value was calculated by chi-square test.

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