Primary evisceration for neonatal endogenous endophthalmitis: A report of two cases

Clinical features, treatment and prognosis of patients with endogenous infectious endophthalmitis

PURPOSE

To investigate whether the clinical characteristics, treatment and prognosis of endogenous infectious endophthalmitis (EIE) have changed over the past 5 years.

METHODS

Retrospectively analyze all articles about EIE published in the PubMed, Web of Science, and Embase databases from 2017 to 2021.

RESULTS

A total of 128 patients and 147 eyes (46 left and 60 right) were included in the study. The mean age at diagnosis was 51 ± 19 years. The most common risk factors were diabetes and intravenous drug use. From 2017 to 2021, Klebsiella was the most common pathogenic microorganism (22%), and vitreous culture had the highest positivity rate. The most common complaint was blurred vision. The mean visual acuity (logMAR) at onset was 2.84, and the clinical symptoms were vitreal inflammation and opacity (63%), ocular pain (37%), and conjunctival congestion (36%). The ocular inflammation could be reduced by intraocular antibiotics or vitrectomy. However, the visual prognosis, with a mean logMAR of 2.73; only 50% of the eyes reached a visual acuity level of finger count and above. Changes in diagnostics over the past 5 years have mainly manifested as more diverse microorganism culture methods. In addition to conventional culture methods, PCR, sputum culture and aqueous humour culture are also commonly used for the diagnosis of pathogenic bacteria, improving the positive culture rate and visual prognosis.

CONCLUSION

The prognosis of EIE is poor. It is recommended to pay attention to the pathogenic bacteria culture results and accompanying systemic diseases and to diagnose and treat patients as soon as possible.

Endogenous Endophthalmitis - A Major Review

Endogenous endophthalmitis (EE) is an uncommon but potentially devastating ocular infection involving the inner layers of the eye. The global incidence of EE is on the rise. Common ocular signs and symptoms associated with EE include conjunctival injection, ocular pain, and reduced visual acuity. On clinical examination, a history of prior or coexisting systemic infections, symptoms (e.g., fever, malaise), and localizing features may be noted. Clinical diagnosis is often challenging, resulting in critical delays that contribute to a poor prognosis. Blood cultures and ocular fluid samples can aid in conforming causative pathogen(s), after which empirical antibiotic therapy, both systemic and intravitreal, should be instated. The use of steroids to suppress inflammation remains controversial. Surgical options include pars plana vitrectomy. Overall prognosis varies depending on host and pathogen factors, and early diagnosis and initiation of appropriate treatment are crucial.

Neonatal Endogenous Endophthalmitis: A Case Report

The aim of this study is to share our experience of a baby boy patient who presented with rare endogenous endophthalmitis that ended up with exudative retinal detachment; emphasizing the clinical presentation, follow-ups progression, and the management plan.

A case report of a one-month-old preterm baby boy presented with eye discharge in his left eye (OS) associated with eyelid swelling and chemosis for four days. His clinical examination revealed a congested left eye with proptosis, absent red reflex, and normal intraocular pressure (IOP) while a portable slit-lamp examination showed an edematous left eye with cloudy cornea but no infiltrates and no view to the posterior segment. Blood, cerebrospinal fluid (CSF), and ocular discharge were cultured, and all came negative and the patient started on empirical antibiotics. B-scan shows dense infiltrates in the vitreous cavity with subretinal fluid. Diagnostic intravitreal paracentesis was done which showed the growth of Pseudomonas aeruginosa and a diagnosis of endogenous endophthalmitis is made then a directed management plan was initiated. Unfortunately, a few days later a repeated B-scan was ordered to the left eye and it shows exudative retinal detachment, and a referral to retinal surgery service was consulted. After further follow-ups, B-scan showed resolving retinal detachment with a short shrunken eye, marked ocular wall thickening, and a relatively short axial length which is consistent with prephthisical changes hence, an oculoplasty referral was done for ocular prosthesis later on.

Endogenous endophthalmitis is a rarely encountered intraocular infection yet it carries devastating consequences that may threaten vision. Therefore, a high index of suspicion is essential for early detection of the disease to prevent serious complications and achieve good visual outcomes.