Clinical profile, diagnostic yield, and visual outcome of endogenous endophthalmitis at a tertiary care hospital in South India

Background: Endogenous endophthalmitis is a relatively rare, but sight-threatening disease. This study will add to existing knowledge on the clinical profile and outcomes in developing nations. Aim: To characterize the clinical course and response to treatment of endogenous ophthalmitis in a hospital in South India. Materials and Methods: We conducted a retrospective analysis of the clinical and microbiological profile and visual outcomes of endogenous endophthalmitis managed at the ophthalmology department at a multispecialty hospital in South India over a 9-year period. Results: There were 32 eyes. The most common focus of infection was a liver abscess, in 63%. The organisms isolated were Streptococcus viridans , Staphylococcus aureus , Klebsiella pneumonia , Basidiobolus ranarum, and Candida albicans . This was the first reported case of Basidiobolus causing fungal endophthalmitis. Blood cultures were positive in 85%. Eighty-eight percent required intravitreal injections and 3% underwent a vitrectomy. 27% of those with presenting visual acuity better than hand movements showed improvement up to 6/36 after intravitreal injections. Initial vision less than hand movements was associated with a worse visual outcome. Visual outcomes were better for Gram-positive organisms. Conclusion: Bacterial etiology was most prevalent (90%), of which S. viridans was the most common organism. Almost half the cases had risk factors for immune compromise in the form of uncontrolled sugars, steroid or immunosuppressive therapy. Our study showed a low requirement for surgical intervention which we believe is due to concomitant treatment with systemic antibiotics and intravitreal injections. Visual outcomes were found to be more favorable with Gram-positive organisms; however, no patient recovered vision completely. Fungal etiologies had the worst visual outcome.