A British Ophthalmological Surveillance Unit Study on metastatic endogenous endophthalmitis

Abstract

PurposeEndogenous endophthalmitis (EE) is a rare but serious ocular infection caused by the seeding of bacteria into the eye from a source elsewhere in the body. Studies suggest that EE accounts for 2 to 8% of all endophthalmitis.MethodsA prospective observational study was conducted using the British Ophthalmological Surveillance Unit reporting system. Questionnaires were sent to reporting Ophthalmologists in the UK to assess incidence, underlying aetiology, eye findings, management, and final outcomes in endogenous endophthalmitis over a 12-month period within the British Isles.ResultsSixty two cases reported with 48 initial questionnaires returned and 25 6-month follow-up questionnaires returned. The median age of patients affected was 57 years with youngest aged 2 years and oldest aged 85 years. Twenty three were male and 24 were female. The median visual acuity in the affected eye was 3 logMAR (range -0.1 to 5). Blood cultures were taken in 36 patients, 58% of which were positive. Vitreous biopsy was taken in 35 patients, 23% of which were culture positive. The visual function as assessed by visual acuity had significantly improved at 6 months with a median acuity of 0.18 logMAR (P=0.003).ConclusionsThe survey demonstrates the severe nature of endogenous endophthalmitis in patients with active infection or with risk factors for infection. Our study has demonstrated that at least half of the patients who were treated had significant vision improvement.

Endogenous Endophthalmitis: yield of the diagnostic evaluation

“…Blood culture positivity was 48.5%, similar to what has been reported elsewhere [4,16]. As in other studies from Western centers [4], Gram-positive organisms were the most commonly identified pathogen.…”

“…Intraocular culture positivity is often low in endogenous endophthalmitis cases, reported at 14-43% in the literature of other centers [2,4,6,[15][16][17]. Given this low diagnostic yield, endophthalmitis must often be treated empirically, such as the initiation of antifungals based on a typical fundus appearance [15].…”

Acute subretinal abscess inStaphylococcus aureussepticaemia with endophthalmitis showcased by multimodal retinal imaging and with 2-year follow-up

“…The foci of primary infection is often in the lung, liver, endocardium or urinary tract 1. The British Ophthalmic Surveillance Unit (BOSU) study recently estimated the incidence of EE in the UK to be at least 1 case per million population per year 2. Jackson et al in a systematic review opined that prognosis of EBE largely depends on prompt recognition and treatment and further observed that 33% of reported patients had delayed diagnosis or were misdiagnosed 1.…”

“…Blurred vision and floaters are frequent presenting complaints, and clinical findings have largely been centred on intraocular inflammation. Where a view of the fundus is possible retinal haemorrhages, cotton wool spots, chorioretinitis and on occasion subretinal abscesses may be identified 1–3. Such subretinal abscesses are infrequent in EBE 2 4…”

“…Individuals at greatest risk of EE include immunocompromised patients; including those on immunosuppressive therapy or HIV, patients with prolonged indwelling devices/catheters and those with underlying systemic comorbidities such as diabetes 1–4…”