Pathogenic organisms and prognostic factors of visual outcome in endogenous endophthalmitis

Objective: To identify pathogenic organisms and prognostic factors associated with the visual outcome in endogenous endophthalmitis patients. Materials and Methods: A retrospective review of medical record from 65 patients diagnosed with endogenous endophthalmitis at Department of Ophthalmology, Siriraj Hospital, Thailand between January 2003 and December 2014 was done. Results: There were 68 eyes from 65 patients diagnosed with endogenous endophthalmitis. Seventy-six percent of patients had initial visual acuity [VA] ranging between hand motion [HM] and light perception. Diabetes mellitus [DM] was the most common underlying disease. The pathogenic organisms could be identified in 48 cases (70.6%). The identified pathogenic organisms were gram-positive bacteria 39.7%, gram-negative bacteria 23.5%, fungus 1.5%, and mixed organisms 5.9%. Most of the pathogenic organisms were Streptococcus spp. (23.5%) and Klebsiella pneumoniae (13.2%). Patients who were treated with vitrectomy have 30% lower rate of enucleation compared to patients who were not treated with vitrectomy (p = 0.007). Among the prognostic factors, good initial VA (better than HM) was significantly related to a successful VA outcome (VA better than HM, p-value <0.001). Nevertheless, approximately 70% of the patients had VA outcome worse than counting finger. Conclusion: The trend of pathogenic organisms may be changing from the past, as the authors found the increasing ratio of gram-positive bacteria over 12 years. Although the patients were treated with sufficient anti-infective agents, most of the visual outcome was poor. Good initial VA was a significant prognostic factor for the visual outcome and vitrectomy could reduce rate of enucleation.