Identifying the risk factors for poor prognosis in eyes with exogenous endophthalmitis may help stave off visual impairment.
Study Design
This was a multicenter, retrospective, observational cohort study of 237 consecutive Japanese patients who presented with infectious exogenous endophthalmitis at one of 13 institutions that compose the Japan Clinical Retina Study (J-CREST) group between 2010 and 2019. Factors associated with legal blindness, including initial best-corrected visual acuity (BCVA), patient characteristics (e.g., age, gender), causative events (e.g., ocular surgery, trauma), pathogens, ocular symptoms, and time from initial onset of symptoms until treatment, were evaluated at 12 weeks after presentation. Patients with BCVA ≥1.0 logMAR (20/200) at 12 weeks after presentation were categorized as having legal blindness.
Outcomes
Causative event, longer time between initial onset of symptoms and treatment, presence of eye pain, poor initial BCVA, and type of pathogen were significantly associated with legal blindness at 12 weeks after initial diagnosis. The most common causative events were cataract surgery, vitrectomy, and glaucoma surgery, while the 2 most common pathogens were coagulase-negative and -positive Staphylococcus aureus.
Limitations
The retrospective study design limits some conclusions from this study. Techniques and prevalence of types of surgery and in-office intravitreal injections across multiple centers may have changed during the 10-year study period. Different laboratories at the centers may have had varying capabilities to detect various pathogens. Lastly, the follow-up interval was only 3 months, a shorter timespan than needed to obtain long-term outcomes data.
Clinical Significance
Endophthalmitis remains a dreaded outcome of ophthalmic surgery and procedures. The authors recommend treatment of the condition as soon as possible after diagnosis in order to reduce the likelihood of legal blindness. As well, clinicians should take steps to reduce possible pathogen contamination during the perioperative period, including the use of intracameral antibiotics during surgery.
Financial Disclosures: Dr. Sherveen Salek discloses no financial relationships.