Seven patients with endogenous klebsiella pneumoniae endophthalmitis / 中华眼底病杂志

ABSTRACT

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.