Endogenous bacterial endophthalmitis - An East Asian experience and a reappraisal of a severe ocular affliction

Purpose: To report 32 eyes of 27 patients with endogenous bacterial endopht halmitis seen over a 4 year period. Features and outcomes of this condition in the current series and the cases reported in the literature from 1986-1 998 were reviewed. Design: Retrospective noncomparative case series. Participants: All patients with this condition seen at the three participat ing general hospitals were included. Intervention: A review of the systemic and ocular characteristics, therapeu tic methods, and final outcomes in patients afflicted with this condition, Main Outcome Measures: Features studied included patients' demographic char acteristics, microbiology, source of infection, ocular features, therapeuti c interventions, final visual and anatomic outcomes. Results: Nineteen (70%) of the 27 incriminating organisms in this case seri es were gram negative microbes, with Klebsiella pneumoniae infections alone being responsible in 16 (60%) cases. Hepatobiliary tract infection was the source of bacteremia in 13 (48%) patients. Only nine (28%) eyes obtained g ood final visual acuity (20/120 or better), and two eyes were enucleated/ev iscerated. A literature review of 209 patients with endogenous endophthalmi tis over a 12 year period showed a similar increase in the frequency of gra m negative microbes as the responsible organism, especially among the East Asian population. Overall, 22% had bilateral involvement; two thirds of pat ients had predisposing factor(s) or underlying illness(es), and diabetes me llitus was present in 46%. Thirty-four percent of all eyes obtained countin g finger or better final vision, and 16% had their eyes eviscerated or enuc leated. Infections with virulent organisms (gram negative rods, Serratia, B acillus) usually denoted a grave visual prognosis; however, a media that wa s not opaque on presentation was usually associated with a good prognosis. Conclusion: Metastatic ocular infection is not uncommon despite the availab ility of modern antibiotic therapy. Among the East Asian population, the pa tient at highest risk is a diabetic patient with Klebsiella pneumoniae hepa tobiliary infection. In contrast, in the Caucasian population, this conditi on occurs in predisposed patients with gram-positive bacteremia arising fro m endocarditis or skin/joint infections. The final visual outcome in patien ts with endogenous bacterial endophthalmitis in the recent 12 years has not differed significantly from five decades ago. Ophthalmology 2000;107:1483- 1491 (C) 2000 by the American Academy of Ophthalmology.