Clinical features and treatment outcomes of endogenous Klebsiella endophthalmitis:a 12-year review

AIM:To identify the clinical features and treatment outcomes of endogenous Klebsiella pneumoniae endophthalmitis and investigate prognostic factors of poor visual outcome.METHODS:The clinical records of all patients diagnosed with endogenous Klebsiella endophthalmitis between January 2007 to December 2018 in Prince of Wales Hospital,Hong Kong,China were retrospectively reviewed.Thorough ophthalmological examination findings were recorded in the case note,including visual acuity testing,slit-lamp examination,indirect ophthalmoscopy and B-scan ultrasonography if media opacity precluded fundus viewing.RESULTS:A total of 18 eyes in 14 patients were identified.Bilateral involvement was noted in 4 patients(28.6%).Hepatobiliary sepsis was the source in 9 patients(64.3%).Culture of intraocular fluid was positive in 5 out of 18 eyes(27.8%).Mortality was noted in 2 patients(14.3%).Mean final visual acuity was 20/1500.Six out of 16 eyes had total loss of sight(37.5%)and 3 eyes required evisceration(18.8%).Multivariate linear regression revealed poor presenting visual acuity(P=0.031)and lack of fundus view due to vitritis(P=0.02)as prognostic factors of poor visual outcome.CONCLUSION:Visual outcome of endogenous Klebsiella endophthalmitis is poor.Poor presenting visual acuity and lack of fundus view predict poor visual outcome.High index of suspicion for endophthalmitis is important in Klebsiella sepsis patients with complaints of ocular symptoms.Ophthalmological screening is recommended in noncommunicable patients with Klebsiella sepsis.

Endogenous fungal endophthalmitis:risk factors,clinical course,and visual outcome in 13 patients

AIM:To analyze the risk factors,ophthalmological features,treatment modalities and their effect on the visual outcome in patients with endogenous fungal endophthalmitis(EFE).METHODS:Data retrieved from the medical files included age at presentation to the uveitis clinic,gender,ocular symptoms and their duration before presentation,history of fever,eye affected,anatomical diagnosis and laboratory evidence of fungal infection.Medical therapy recorded included systemic antifungal therapy and its duration,use of intravitreal antifungal agents and use of oral/intravitreal steroids.Surgical procedures and the data of ophthalmologic examination at presentation and at last follow-up were also collected.RESULTS:Included were 13 patients(20 eyes,mean age 58 y).Ten patients presented after gastrointestinal or urological interventions and two presented after organ transplantation.In one patient,there was no history of previous intervention.Diagnostic vitrectomy was performed in 16 eyes(80%)and vitreous cultures were positive in 10 of the vitrectomized eyes(62.5%).In only 4 patients(31%),blood cultures were positive.All patients received systemic antifungal therapy.Sixteen eyes(80%)received intravitreal antifungal agent with voriconazole being the most commonly used.Visual acuity(VA)improved from 0.9±0.9 at initial exam to 0.5±0.8 logMAR at last followup(P=0.03).A trend of greater visual improvement was noted in favor of eyes treated with oral steroids(±intravitreal dexamethasone)than eyes that were not treated with steroids.The most common complication was maculopathy.Twelve eyes(60%)showed no ocular complications.CONCLUSION:High index of suspicion in patients with inciting risk factors is essential because of the low yield of blood cultures and the good general condition of patients at presentation.Visual prognosis is improved with the prompt institution of systemic and intravitreal pharmacotherapy and the immediate surgical intervention.Oral±local steroids could be considered in cases of prolonged or marked inflammatory responses in order to hasten control of inflammation and limit ocular complications.