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Microbial keratitis-induced endophthalmitis: incidence, symptoms, therapy, visual prognosis and outcomes.
- Source :
-
BMC ophthalmology [BMC Ophthalmol] 2018 May 03; Vol. 18 (1), pp. 112. Date of Electronic Publication: 2018 May 03. - Publication Year :
- 2018
-
Abstract
- Background: To evaluate symptoms, therapies and outcomes in rare microbial keratitis-induced endophthalmitis.<br />Methods: Retrospective study with 11 patients treated between 2009 and 2014. Clinical findings, corneal diseases, history of steroids and trauma, use of contact lenses, number and type of surgical interventions, determination of causative organisms and visual acuity (VA) were evaluated.<br />Results: The incidence of transformation from microbial keratitis to an endophthalmitis was 0.29% (n = 11/3773). In 90.9% (n = 10/11), there were pre-existent eyelid and corneal problems, in 45.5% (n = 5/11) rubeosis iridis with increased intraocular pressure and corneal decompensation, and in 18.2% (n = 2/11), ocular trauma. Specimens could be obtained in 10 of 11 samples: 33.3% of those 10 specimens were Gram-positive coagulase-negative Staphylococci (n = 3/10) or Gram-negative rods (n = 3/10) and 10.0% Staphylococcus aureus (n = 1/10). In 30% (n = 3/10), no pathogens were identifiable. 72.7% (n = 8/11) of all keratitis-induced endophthalmitis were treated with vitrectomy and 9.1% (n = 1/11) with amniotic-membrane transplantation. In 27.3% (n = 3/11) the infected eye had to be enucleated - 18.2% (n = 2/11) primarily, 9.1% (n = 1/11) secondarily. No patient suffered from sympathetic ophthalmia. The median initial VA was 2.1 logMAR (n = 11/11). At one month, median VA was 2.0 logMAR (n = 7/11), after three months 2.0 logMAR (n = 6/11), and after one year 2.05 logMAR (n = 6/11). The change in VA was not significant (p > 0.99). 36.4% (n = 4/11) of the cases resulted in blindness.<br />Conclusions: The overall outcome is poor. Enucleation should be weighed against the risk of local and systemic spread of the infection, prolonged rehabilitation and sympathetic ophthalmia.
- Subjects :
- Adult
Aged
Aged, 80 and over
Anti-Bacterial Agents therapeutic use
Endophthalmitis epidemiology
Endophthalmitis physiopathology
Endophthalmitis therapy
Eye Enucleation statistics & numerical data
Eye Infections, Bacterial epidemiology
Eye Infections, Bacterial microbiology
Female
Gram-Negative Bacterial Infections complications
Gram-Positive Bacterial Infections complications
Humans
Incidence
Keratitis epidemiology
Keratitis microbiology
Male
Middle Aged
Prognosis
Retrospective Studies
Risk Factors
Steroids therapeutic use
Visual Acuity
Vitrectomy statistics & numerical data
Endophthalmitis etiology
Eye Infections, Bacterial complications
Keratitis complications
Subjects
Details
- Language :
- English
- ISSN :
- 1471-2415
- Volume :
- 18
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- BMC ophthalmology
- Publication Type :
- Academic Journal
- Accession number :
- 29724209
- Full Text :
- https://doi.org/10.1186/s12886-018-0777-3