Comparison of Endogenous Endophthalmitis in Patients with and Without COVID-19 Infection

Abstract

Introduction. Endogenous endophthalmitis (EE) is an ophthalmic emergency that can have severe sight-threatening complications. Prompt diagnosis and aggressive treatment are central to the successful management of EE. In recent years, a significant increase has occurred in the number of cases of EE. Some of these individuals had a COVID-19 infection. The current study compared EE in patients with and without COVID-19 infection. Methods. All cases of EE admitted to Khalili Hospital between April 2020 and September 2021 were included in this prospective case-control study. Patients were divided into 2 groups: (i) the case group (EE patients with confirmed COVID-19 infection; n = 7) and (ii) the control group (EE patients without a history or evidence of COVID-19 infection; n = 7). Age, sex, presenting and final visual acuity, systemic diseases and risk factors for EE, anterior segment and fundus findings, hospitalization due to COVID-19, intensive care unit (ICU) admission, systemic steroid therapy, results of the sepsis workup, causative microorganism, types of treatment (pars plana vitrectomy vs. intravitreal or antifungal antibiotics), and follow-up period were recorded. Results. Twenty-four eyes of the 14 patients were included in this study, of which 9 were female. The mean age was 49.57 years. Follow-ups ranged from 1 month to 20 months (mean, 8 months). There were no statistically significant differences in age (P = 0.653), mean follow-up (P = 0.943), gender (P = 0.313), and clinical presentation (P = 0.409) between the case and control groups. Seven patients (50%) had positive intraocular culture results. Two out of 7 patients had a history of COVID-19 infection. The most common causative microorganism was Candida (4 patients [28.57%]; 6 eyes [25%]). No statistically significant differences were observed between the 2 groups in the need for vitrectomy (P = 1.000). The visual outcome between the 2 groups was similar (P = 0.179). Conclusion. The COVID-19 infection does not seem to affect the severity, visual outcomes, improvement rate, or vitrectomy rate of EE. Early diagnosis and management, especially pars plana vitrectomy, can prevent serious complications and save many eyes.

Endogenous Endophthalmitis: A 10-Year Review of Cases on the East Coast of Malaysia

“…In our study, the mean age at presentation was 54.9 ± 13.3 years, consistent with findings indicating a peak incidence during the fifth decade of life [ 1 , 3 - 6 , 8 , 9 , 14 - 20 ]. Despite certain previous reports of a male predominance [ 2 - 4 , 6 , 8 , 14 , 16 , 19 , 21 , 22 ], our study observed a higher incidence among women (55.0%), which tallied with studies reported by Michael et al and Namvar et al [ 9 , 23 ]. Left-eye involvement was observed in 58.3% of our patients.…”

“…In 71.4% of cases of endogenous endophthalmitis secondary to liver abscess, we observed that Klebsiella pneumoniae were found to be positive, consistent with other published studies [ 19 , 21 , 22 , 27 ], suggesting close monitoring of patients with such infections. With regards to the visual outcome, we did not find any significant association between Klebsiella species and poor visual outcomes, in contrast with Chen et al and Ghiam et al [ 21 , 28 ]. Liver abscesses are associated with Klebsiella pneumoniae due to its ability to trigger a metastatic infection, particularly in individuals with conditions such as diabetes or chronic liver disease.…”

“…Our study demonstrated a poor visual outcome in endogenous endophthalmitis cases, particularly in cases of gram-negative infections, where 22% of eyes showed visual deterioration post-treatment. This aligns with other data indicating that gram-negative infections tend to lead to a poorer visual prognosis compared to gram-positive infections [ 4 , 9 , 14 , 16 , 21 , 22 ]. This could be due to the rapid progression of disease contributed by its virulence factors, higher level of antibiotic resistance, and robust inflammatory response.…”

“…In contrast, Callegan et al and Connell et al reported that intravenous drug abuse was the most common predisposing factor instead of diabetes mellitus [ 20 , 25 ]. Most of our patients had identifiable sources of infection, with genitourinary infections and liver abscesses being the most common at 23.3% and 11.7%, respectively, similar to other published data [ 1 , 5 , 8 , 9 , 14 , 18 , 21 ]. Other studies also reported a high prevalence of catheter-related infections, with infective endocarditis being the most prominent source of infection [ 13 , 14 ].…”

“…Diabetes mellitus was the most prevalent predisposing factor, affecting 88.3% of our patients. This finding was consistent with most reported studies [1,[3][4][5][6]9,[13][14][15][18][19][20][21][22]24]. In contrast, Callegan et al and Connell et al reported that intravenous drug abuse was the most common predisposing factor instead of diabetes mellitus [20,25].…”