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- Document type:
- Journal Article; English Abstract
- Author(s):
- Mayer, Christian; Loos, Daria; Feucht, Nikolaus; Zapp, Daniel; Prahs, Philipp Maximilian; Tandogan, Tamer; Khoramnia, Ramin
- Title:
- [Endogenous Endophthalmitis: Epidemiology, Clinic, Therapy and Visual Outcome].
- Abstract:
- BACKGROUND: Endogenous endophthalmitis is a rare and severe inflammation of the eye in the context of a systemic infectious disease, which can lead to the loss of the affected eye in the worst case. MATERIAL AND METHODS: In a 5-year period, 20 eyes were treated for endogenous endophthalmitis and evaluated retrospectively. Evaluation parameters were epidemiological data, causes, concomitant diseases, assessment of the pathogen spectrum, therapy and visual acuity. RESULTS: 13.2% (n = 20/152; 20 eyes of 17 patients) of all endophthalmitis cases were of endogenous origin. In 15% (n = 3/20) of the cases, bilateral endogenous endophthalmitis was present. The cause for the endophthalmitis was generalised sepsis in 9 of 17 cases, an infection of the urogenital tract in 2 of 17 cases and endocarditis and liver abscess in 1 of 17 cases, respectively. In 4 of 17 cases, no primary foci were detected. Eight of 17 patients suffered from diabetes mellitus, 6 of 17 from renal insufficiency and 2 of 17 from malignancies, pneumonia or rheumatism. Two of 17 patients had had an organ transplantation, 15 of 17 suffered from cardiovascular diseases, 3 of 17 were immunosuppressed and 2 of 17 reported drug abuse. Four of 17 infections were caused by streptococci, 3 of 17 by Candida, 2 of 17 by herpes viruses and 1 of 17 by Staphylococcus aureus and Bacillus cereus. No pathogen could be found in 5 cases. The time interval between the onset of symptoms and diagnosis and the beginning of the therapy was 4 days (min.: 1 day; max.: 39 days). This was significantly longer in comparison with other causes of endophthalmitis (p < 0.001). Median visual acuity (VA) was 2.0 logMAR (n = 19/20) at the first presentation. One month and three months after initiation of the therapy VA was 1.3 logMAR (both n = 15/20), VA was 0.1 logMAR (n = 9/20) at the one year follow-up. Retinal detachment occurred in 2 of 20 eyes and recurrence of the endophthalmitis in 1 of 20 eyes within the one year follow-up, 5 of 17 patients died. Enucleation was never necessary. CONCLUSION: Endogenous endophthalmitis is often misdiagnosed due to a severe underlying non-ophthalmological disease. Delayed presentation with consequent late initiation of therapy is an unresolved problem, because colleagues from other fields are often unexperienced in diagnosing the ocular infection. This is also a cause of the already poor visual prognosis. Ophthalmologists can usually only influence the choice of the proper therapy.
- Journal title abbreviation:
- Klin Monatsbl Augenheilkd
- Year:
- 2019
- Journal volume:
- 236
- Journal issue:
- 10
- Pages contribution:
- 1208-1214
- Fulltext / DOI:
- doi:10.1055/s-0044-101152
- Pubmed ID:
- http://view.ncbi.nlm.nih.gov/pubmed/29642263
- Print-ISSN:
- 0023-2165
- TUM Institution:
- Klinik und Poliklinik für Augenheilkunde
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