Background: Cases of endogenous bacterial endophthalmitis were analysed regarding predisposing factors, timing of diagnosis, sources of infection, causative organisms, and visual outcome. The value of an immediate vitrectomy compared to exclusively injected intravitreal antibiotics was evaluated reviewing the literature.
Methods: Records of 22 consecutive cases of the last 9 years with endogenous bacterial endophthalmitis were reviewed. The identified source of infection was treated with systemic antibiotics. All affected eyes were treated with intraocular injection of antibiotics, whenever possible combined with vitrectomy.
Results: 90% of the patients had severe predisposing diseases, primarily diabetes mellitus combined with renal insufficiency and urinary tract infection (70%). Diagnoses were made 3.5 days after beginning of symptoms. An average of 75% of the patients had gram-positive and 25% gram-negative bacteria as causative organisms. Most common gram-positive bacteria were Staphylococcus aureus and S. epidermidis. In 73% of all eyes vitrectomy was used as primary treatment. In 57% of the cases the visual outcome was light perception or better (excluding primary enucleations and deceased patients). 7% of the eyes had no light perception, 36% underwent secondary enucleation. Especially in cases of early diagnoses (less than or equal to 2 days) therapy was successful (60% of the patients); in contrast to delayed diagnoses (33%). The literature review suggests that immediate vitrectomy is superior to exclusive intravitreal injection of antibiotics concerning bulb conservation and remaining function.
Conclusions: Immediate diagnosis and therapy are crucial for a positive outcome in this ophthalmological emergency. Immediate pars plana vitrectomy with intraocular antibiotic instillation seems to improve the prognosis of the affected eyes.