This retrospective case series found that progression of infectious keratitis to endophthalmitis is relatively uncommon. The results suggest that patients at higher risk for progression to endophthalmitis include those using topical corticosteroids or those with fungal keratitis, corneal perforation, or infectious keratitis developing adjacent to a previous surgical wound. Patients with sequential keratitis and endophthalmitis generally have poor visual outcomes.
The study included all patients treated for culture-proven keratitis and endophthalmitis between 1995 and 2009 at the Bascom Palmer Eye Institute. During this time, 9,934 corneal cultures were performed for suspected infectious keratitis.
Forty-nine eyes (0.5 percent) progressed to culture-proven endophthalmitis. Fungi were the most common responsible organism followed by gram-positive bacteria and gram-negative bacteria.
Topical steroid use was the most common associated factor, followed by previous surgery, corneal perforation, dry eye, relative immune compromise, organic matter trauma, and contact lens wear.
In 27 patients, a primary infectious keratitis developed into endophthalmitis, and in 22 patients, an infectious keratitis adjacent to a previous surgical wound progressed into endophthalmitis. Patients in the primary keratitis group were more likely to be male, have a history of organic matter trauma and have fungal etiology. Patients in the surgical wound-associated group were more likely to use topical steroids.
Visual acuity of ≥ 20/50 was achieved in 7 of 49 patients (14 percent) but was < 5/200 in 34 of 49 (69 percent) at last follow-up. Enucleation or evisceration was performed in 15 of 49 patients (31 percent).
Some other factors may have predisposed patients to infection. Patients tended to be older, with an average age of 61.4 years. Relative immune compromise from HIV, leukemia/lymphoma or diabetes mellitus was seen in 20 percent of patients, which is higher than the prevalences in the general population of 8.3 percent for diabetes mellitus and 0.4 percent for HIV.