Predictive factors in the treatment of streptococcal endophthalmitis

Abstract

ObjectiveTo evaluate visual outcomes and possible predictive factors in the treatment of infectious endophthalmitis caused by Streptococcus species during 2012–2016 at a large referral eye center in northeastern Thailand.MethodsA retrospective medical record chart review of patients with culture-positive endophthalmitis caused by Streptococcus species was conducted. Demographic data including age, gender, occupation, duration of symptoms, time to surgery, surgical procedures, initial visual acuity at presentation, and final visual acuity after treatment were collected and analyzed. Possible predictive factors associated with improved visual outcomes were also studied.ResultsForty-five eyes of 45 patients were recruited for the study. The 3 most common types of endophthalmitis were postoperative (35.56%), posttraumatic (20%), and endogenous (15.56%). At presentation, most patients (95.56%) had visual acuity of hand motion (55.56%), light perception (28.89%), or no light perception (11.11%). The 3 most common isolates were Streptococcus pneumoniae (44.44%), Group B β-hemolytic Streptococcus (26.68%), and Streptococcus viridans (20%). Most patients (62.22%) were treated with surgical interventions, either pars plana vitrectomy with intravitreal antibiotics or pars plana vitrectomy with intravitreal antibiotics and silicone oil tamponade. After treatment, improved visual outcome was noted in only 9 patients (20%), and no visual improvement was seen in 36 patients (80%). Evisceration and enucleation were performed in 15 patients (33.33%). The only possible predictive factor associated with improved visual outcomes was early vitrectomy, performed within 3 days.ConclusionStreptococcal endophthalmitis is often associated with poor visual prognosis. Only 9 patients (20%) had improved vision after treatment. The only possible predictive factor associated with improved visual outcomes was vitrectomy within 3 days. Early diagnosis and early vitrectomy are therefore recommended.

Clinical analysis and predictive factors associated with improved visual acuity of infectious endophthalmitis

“…According to our data analysis, there was a relationship between different therapy and vision improvement. According to figure 1 and table 4, in addition to enucleation, the improvement of visual acuity was statistically significant by various treatment methods, and in the PPV group was significantly higher than that in other groups, which was similar to the results of other researches [4,6]. Therefore, PPV is the main therapy strategies in infectious endophthalmitis [4,5,22].…”

“…Streptococci can produce severe endophthalmitis with a poor visual outcome, whereas coagulasenegative staphylococci cause milder endophthalmitis in general [5]. Yosanan et al found that the only possible predictive factor associated with improved visual outcomes was PPV within 3 days [6].…”

Etiology, microbiological isolates, and antibiotic susceptibilities in culture-proven pediatric endophthalmitis: a 9-year review

“…These shifting trends suggested that age may influence the microbiological spectrum of endophthalmitis. Previous studies demonstrated that streptococcal infection was associated with poor vision outcome in endophthalmitis [36][37][38]; therefore, a higher proportion of streptococcal infections in children, especially in younger children, merits clinical attention. Antibiotic resistance is a topic of concern worldwide.…”

Clinical analysis and predictive factors associated with improved visual acuity of infectious endophthalmitis

“…The patients were classified as having "improved" VA when their best-corrected VA (BCVA) rates were better post-therapy than pre-therapy. They were classified as "not improved" when the final BCVA rates were stable or worse than the initial values [6].…”

“…Durand reported that there was a reasonably high correlation between the visual outcome and pathogenic microbiology [5], Streptococci can produce severe endophthalmitis with a poor visual outcome, whereas coagulase-negative staphylococci cause milder endophthalmitis in general. Yosanan et al found that the only possible predictive factor associated with improved visual outcomes was pars plana vitrectomy (PPV) within 3 days [6].…”