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Objective To observe and analyze the clinical features and prognosis of endogenous klebsiella pneumoniae endophthalmitis (EKPE).Methods This is a retrospective case series study.Seven patients (8 eyes) with EKPE were enrolled in this study.There were 3 males (4 eyes) and 4 females (4 eyes).The ages were from 39 to 76 years,the mean age was 57.29 years.All these cases had no history of trauma and surgery.Meanwhile,they all had some risk factors,such as infection,diabetes mellitus,systemic lupus erythematosus,liver abscess,renal insufficiency undergoing dialysis treatment,Hodgkin lymphoma and so on.All the eyes were undertaken visual acuity,slit lamp and fundus examination to observe the eye conditions.Seven eyes were undertaken pars plana vitrectomy with intravitreal injection of antibiotics from 2 days to 2 weeks after onset.And only one eye was undertaken intravitreal injection of antibiotics without surgery.Microbial stains and culture were performed for 7 eyes using vitreous and aqueous fluid samples from the procedures of vitrectomy.Meanwhile,culture and drug sensitive tests were performed from blood samples.According to the result of the drug sensitive tests,carbapenems such as imipenem and meropenem were used in each patient through intravenous injection from 1 to 2 weeks.During the follow up period from 3 days to 1 year,prognosis was observed at each office visit.Results From these eight eyes,presenting visual acuity was light perception (4 eyes),hand motion (3 eyes),0.1 (1 eye).Hypopyon (6 eyes),aqueous fluid opacity (2 eyes) and diffuse vitreous opacity (8 eyes) were found.Changes in fundus like optic disc,macular edema and retinal vascular occlusion could be observed.Cultures of the vitreous and aqueous fluid samples from vitrectomy were all point out to klebsiella pneumoniae.At last office visit,the visual acuity of patients with hypopyon was no light perception (1 eye),light perception (1 eye),hand motion (1 eye).The visual acuity of patients without hypopyon was 0.05 (1 eye) and 0.5(1 eye).Finally,1 eye was underwent enucleation and one patient with binocular disease was died of multiple organ failure.Conclusions EKPE is almost unilateral attacked.Changes in fundus like optic disc,macular edema and retinal vascular occlusion can be observed.EKPE is commonly associated with poor visual outcomes.It is useful to save patients' visual acuity by performing vitrectomy before hypopyon happened.
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Objective To observe the clinical features and prognosis of endogenous bacterial endophthalmitis (EBE).Methods Ten eyes of 10 patients diagnosed with unilateral EBE were retrospectively reviewed,including 7 males and 3 females.The mean age was 57.6± 10.8 years old.Eight patients were with diabetes and 7 of them were diagnosed over 5 years.There were 3 patients with hepatocirrhosis,1 patient with hypertension,and 1 patient with coronary disease.Nine cases had infectious diseases,including liver abscess (7 cases),pulmonary infection (3 cases),erysipelas (1 case) and perianal abscess (1 case).Seven cases had fever history.Culture and drug sensitive tests for aerobic bacteria,anaerobic bacteria and fungal were performed for 9 eyes using vitreous samples from the procedures of vitrectomy and/or intravitreal injection.All patients were treated with broad-spectrum antibiotics and adjusted for drug use according to microbiological culture and drug sensitivity test results.After the diagnosis was established,vitrectomy combined with lens removal was performed in 5 hours (3 eyes) and 24 hours (5 eyes);Vitreous tamponade of C3F8 (1 eye) and silicone oil (7 eyes) was used;At the end of the operation,0.1 ml vancomycin (1 mg) and 0.1 ml ceftazidime (1 mg) were injected into the vitreous cavity.One eye received intravitreal injection of 0.1 ml vancomycin (1 mg) and 0.1 ml ceftazidime (mg),one eye received evisceration.During the follow up period from 6 to 24 months,visual function,slit lamp and fundus examinations were performed at each office visit.Results All patients complained of blurred vision and 5 patients had ocular pain.The visual acuity was no light perception (3 eyes),light perception (5 eyes);hand motion (1 eye) and 0.1 (1 eye).Corneal edema was found in all 10 eyes;hypopyon in 8 eyes;diffuse vitreous opacity in 10 eyes,including 3 eyes with retinal detachment.For 8 eyes treated by vitrectomy and intravitreal injection,1 eye was eviscerated due to uncontrolled inflammation.The eye treated with intravitreal injection was enucleated for its uncontrolled inflammation.For 9 eyes received vitreous culture and drug testing,8 eyes (88.9％) had positive results,including 5 eyes with Klebsiellar pneumonia,and 1 eye with Staphylococcus aureus,or Streptococcus agalactiae or Enterococcus faecalis respectively.At last office visit,2 eyes were with no light perception;4 eyes were with hand motion;and 1 eye with visual acuity of 0.1.Conclusions Most of the patients with endogenous bacterial endophthalmitis have systemic predisposing factors.Klebsiella pneumoniae is the leading cause of ocular EBE.Vitrectomy combined with intravitreal injection of antibiotics showed efficacy in treating EBE.
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ObjectiveTo investigate the etiological factors of endophthalmitis and evaluate the outcomes of vitrectomy for endophthalmitis.MethodsFrom January 1999 to December 2001, 53 consecutive patients (54 eyes ), 38 men and 15 women, diagnosed as endophthalmitis were retrospectively evaluated. The patients′ ages ranged from 1 year to 74 years (mean 32 years). Two patients (2 eyes) with mild inflammation received antibiotic medication therapy, 5 patients (5 eyes) with no light perception and severe inflammation underwent evisceration, and the other 46 patients (47 eyes) underwent pars plana vitrectomy. Postoperative follow-up ranged from 2 to 32 months (mean 10.5 months). ResultsEndophthalmitis was diagnosed as resulting from penetrating injury in 32 eyes (59.26%), endogenous endophthalmitis in 8 eyes (14.81%), cataract surgery in 7 eyes (12.96%), glaucoma surgery in 2 eyes (3.70%), vitrectomy in 3 eyes (5.56%), radial keratotomy in 1 eye (1.85%), and unknown reason in 1 eye (1.85%). The postoperative visual acuities (VA) of these patients increased significantly (P=0.003). The VA of the patients underwent vitrectomy in 3 days was obviously better than those after 3 days (P=0.014), and the VA of the patients underwent vitrectomy in 7 days was obviously beter than those after 7 days (P=0.021). Thirty-seven eyes (68.52%) had functional success (VA≥0.02), 47 eyes (87.04%) had anatomical success (VA
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Objective To investigate the surgical treatment and early intravitreal injection of antibiotics to the curative effects of vitrectomy for exogenous endophthalmitis. Design Retrospective case-controlled study. Participants From Jan 2000 to Dec 2004, 94 patients(94 eyes), diagnosed as endophthalmitis were evaluated retrospectively. Methods All patients underwent pars plana vitrectomy. 46 patients (46 eyes) underwent the intravitreal injection of antibiotics early before undergoing vitrectomy from 3 to 14 days (mean 5.6 days) (group Ⅰ). The other 48 patients (48 eyes) underwent vitrectomy directly (group Ⅱ). Postoperative follow-up ranged from 3 to 12 months (mean 7.5 months). Main Outcome Measures Visual acuity. Results The visual acuities of these 94 patients improved significantly after vitrectomy (P=0.000). The rate of curative effects in group Ⅰ was significantly higher than that of the group Ⅱ (P=0.029). According to the further analysis, the rates of curative effects of the patients underwent vitrectomy in 7 days were similar between group Ⅰ and group Ⅱ(P=0.692), but the rates of curative effects of the patients underwent vitrectomy after 7 days were obviously different between two groups (P=0.008). Conclusions Undergoing vitrectomy as early as possible is a good available method for the treatment of exogenous endophthalmitis. If the vitrectomy can not be undergone early, intravitreal injection of antibiotics in time before vitrectomy may increase the therapeutic effect of exogenous endophthalmitis obviously.