Endophthalmitis: Epidemiology, Causing Agents, Therapy and Visual Outcome with Special Focus on Glaucoma Patients

Abstract

Background Endophthalmitis is one of the most serious emergencies in ophthalmology. In order to reduce its prevalence, it is important to have a proper understanding of potential risk. Surgical therapy with targeted, pathogen-specific medication and an intact immune system are fundamental for preserving visual acuity. As it is unclear whether an unfavourable course is more likely in the presence of underlying ocular disease, a comparison was made between glaucoma patients (G) and non-glaucoma patients (NG) in terms of causative factors, pathogens, treatment and visual acuity. Since a potential alteration of the local immune system in glaucoma has been described, it is of interest to determine whether the clinical course of endophthalmitis in glaucoma patients differ from that of non-glaucoma patients.

Patients and Methods A retrospective analysis of 75 eyes (13 G, 62 NG) who underwent treatment and surgery following a diagnosis of endophthalmitis in the Department of Ophthalmology, University of Erlangen-Nuremberg has been evaluated over a period of 5 years. Clinical characteristics, surgical treatment, microbial spectrum and visual acuity in glaucoma and non-glaucoma eyes were investigated.

Results Severe visual impairment (44%) with inflammation of the anterior chamber (62.7%), hypopyon (52%) and reduced (40%) or absent view (26.7%) of the fundus were predominantly present at first diagnosis in all patients. Previous eye surgery was observed in a total of 53%, primarily cataract surgery. Gram-positive cocci were seen as the most common causative agent in both groups, (G: 23.1%; NG: 38.7%), whereas other rare pathogens were present only in glaucomatous eyes. Pars plana vitrectomy was performed in 76% and enucleations in 20% of all patients, with the latter significantly more common in glaucomatous eyes (p = 0.01). A significant postoperative improvement in visual acuity was achieved in non-glaucoma patients (p < 0.001); visual acuity was worse in glaucomatous eyes.

Conclusion Although rare, early diagnosis and treatment of endophthalmitis is crucial in terms of prognosis. In the present cohort, worse visual acuity outcomes were obtained in glaucoma patients in comparison to non-glaucoma patients.

Fazitbox

Bereits bekannt:

• Trotz intensiver Therapien sind Endophthalmitiden primär mit einem schlechten visuellen Outcome verbunden.

• Da dies bislang nicht beschrieben war, wurde ein Vergleich der klinischen Verläufe zwischen Glaukom- und Nichtglaukompatienten gezogen.

Neu beschrieben:

• Das visuelle Outcome nach Endophthalmitis bei Glaukompatienten war schlechter als bei nicht glaukomatös vorerkrankter Augen.

• Ursächlich hierfür könnten neben dem Vorkommen seltener, aggressiver Erreger auch vorbestehende Ulcera corneae sein, weshalb Glaukompatienten signifikant häufiger einer Enukleation unterzogen wurden.

• Auch pathologische Veränderungen des Immunsystems könnten bei Glaukompatienten eine Rolle spielen.

Conclusion Box

Already known:

• Despite intensive treatment, endophthalmitis is usually associated with poor visual outcomes.

• Since this has not been described previously, a comparison was made between the clinical courses of glaucoma and non-glaucoma patients.

New findings:

• Visual outcomes after endophthalmitis in glaucoma patients was worse than in non-glaucoma patients.

• This could be due to the presence of rare, aggressive pathogens as well as pre-existing corneal ulcers, which is why glaucoma patients underwent enucleation significantly more often.

• Pathologic changes in the immune system may also play a role in glaucoma patients.

Key words

endophthalmitis - glaucoma - infection

Publication History

Received: 17 April 2022

Accepted: 24 May 2022

Accepted Manuscript online:
08 July 2022

Article published online:
30 September 2022

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