Surgical Outcomes of Endogenous Endophthalmitis Caused by Hypervirulent Klebsiella pneumoniae

Abstract

Background Endogenous Klebsiella pneumoniae endophthalmitis has been a complex challenge for both ophthalmologists and physicians, characterized by its unpredictable onset, nonspecific initial symptoms, difficulty in early diagnosis, and serious implications for visual prognosis. To determine the surgical outcomes and visual acuity (VA)-related prognostic factors for patients with endogenous endophthalmitis caused by hypervirulent Klebsiella pneumoniae (hvKp-EE). Methods We retrospectively analyzed the records of patients diagnosed with hvKp-EE at Huashan Hospital between September 2014 and January 2022. The statistical analysis involved hypothesis testing, which was conducted using the SPSS 26.0. Results We enrolled 51 eyes (43 patients) with hvKp-EE who underwent pars plana vitrectomy (PPV). Postoperatively, the mean logMAR VA increased from 2.27 ± 0.57 to 2.15 ± 0.72. The VA preservation rate was 86.67%, with 26 eyes achieving a VA ≥ 20/2000. Vision improved in 21 patients during follow-up. A final VA > = 20/2000 was reported for 19 (79.17%) and 7 (25.93%) individuals who had early and late PPVs, respectively (p < 0.001). Late PPV surgery predicted poor visual results (p = 0.031). The average number of extraocular infection sites was 2.49. All patients received systematic antibiotics, and 22 of the 36 patients had liver abscesses drain. The hvKp-EE risk factors included corneal edema, poor preoperative VA, and late PPV. Conclusions HvKp-EE patients who underwent early vitrectomy had better VA results. Late surgery, ocular edema, and inadequate initial VA (worse than 20/2000) were risk factors for poor outcomes.