Pathogenic Organisms and Prognostic Factors of Visual Outcome in Endogenous Endophthalmitis
Nichawan Teerittikul MD1, Somanus Thoongsuwan MD1, Jutalai Tanterdtham MD1, Nopasak Phasukkijwatana MD1, Supalert Prakhunhungsit MD1, Sasima Tongsai PhD2, Chakrapong Namatra MD1
Affiliation : 1 Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand 2 Clinical Epidemiology Unit, Of(cid:976)ice for Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Objective : To identify pathogenic organisms and prognostic factors associated with the visual outcome in endogenous
endophthalmitis patients.
Materials and Methods : A retrospective review of medical record from 65 patients diagnosed with endogenous endophthalmitis
at Department of Ophthalmology, Siriraj Hospital, Thailand between January 2003 and December 2014 was done.
Results : There were 68 eyes from 65 patients diagnosed with endogenous endophthalmitis. Seventy-six percent of patients had
initial visual acuity [VA] ranging between hand motion [HM] and light perception. Diabetes mellitus [DM] was the most common
underlying disease. The pathogenic organisms could be identi(cid:976)ied in 48 cases (70.6%). The identi(cid:976)ied pathogenic organisms were
gram-positive bacteria 39.7%, gram-negative bacteria 23.5%, fungus 1.5%, and mixed organisms 5.9%. Most of the pathogenic
organisms were Streptococcus spp. (23.5%) and Klebsiella pneumoniae (13.2%). Patients who were treated with vitrectomy have
30% lower rate of enucleation compared to patients who were not treated with vitrectomy (p = 0.007). Among the prognostic
factors, good initial VA (better than HM) was signi(cid:976)icantly related to a successful VA outcome (VA better than HM, p-value <0.001).
Nevertheless, approximately 70% of the patients had VA outcome worse than counting (cid:976)inger.
Conclusion : The trend of pathogenic organisms may be changing from the past, as the authors found the increasing ratio of gram-
positive bacteria over 12 years. Although the patients were treated with suf(cid:976)icient anti-infective agents, most of the visual outcome
was poor. Good initial VA was a signi(cid:976)icant prognostic factor for the visual outcome and vitrectomy could reduce rate of enucleation.
Keywords : Endogenous endophthalmitis, Pathogenic organisms, Risk factors, Treatment, Vitrectomy, Enucleation
