A Retrospective Review of Endogenous Endophthalmitis: Three Years of Experience at Sultan Ahmad Shah Medical Centre at International Islamic University Malaysia.

Introduction Endogenous endophthalmitis is characterized by severe intraocular inflammation caused by the invasion of microorganisms into the anterior and posterior chambers of the eye. It results from hematogenous spread from distant foci of infection. This, in turn, leads to potential vision loss and blindness due to reduced anatomical and functional outcomes. The latest reported prevalence of endogenous endophthalmitis accounts for at least 2-8% of cases of general endophthalmitis which is fairly significant. Purpose This study aimed to analyze the clinical profile of endogenous endophthalmitis presented in the Ophthalmology Clinic, Sultan Ahmad Shah Medical Centre at International Islamic University Malaysia (SASMEC@IIUM). This study includes the patients' demographics, clinical manifestations, causative organism, treatment, and final visual outcome. Methods This is a retrospective case series of endogenous endophthalmitis patients from January 2020 to June 2023. The data were obtained from the patients' medical records in SASMEC@IIUM. Results A total of six patients (six eyes) were diagnosed with endogenous endophthalmitis from January 2020 to June 2023. Four patients (66.6%) were female, with a mean age of 51.6 ± 17.5 years. Presenting visual acuity ranged between 6/21 to hand movement (HM). Five patients (83.3%) presented with reduced vision, while one presented with eye redness (16.6%). Ocular signs included vitritis and retinitis (five eyes, 83.3%), hypopyon (five eyes, 83.3%), injected conjunctiva (five eyes, 83.3%), and eyelid swelling (one eye, 16.6%). The most common primary infection seen was intraabdominal sepsis (three patients, 50%), septic arthritis, hospital-acquired pneumonia (HAP), and urinary tract infection (UTI). Vitreous biopsy was only positive in two patients (33.3%) However, five out of the six patients (83.3%) had positive blood cultures (two Staphylococcus aureus, two Klebsiella pneumoniae and one Pseudomonas aeruginosa). All patients received intravitreal injections and intravenous antibiotics. Only one patient underwent subsequent trans pars plana vitrectomy (TPPV). Final visual acuity ranged from 6/6 to no light perception (NPL). Conclusion In this case series of six patients, we observed a variety of outcomes with similar presentations despite standardized treatment in all patients. Five out of six patients showed poorer visual outcomes and only one patient showed a final visual acuity of 6/6. Therefore, further study with a larger sample size is needed to evaluate the factors associated with the final visual outcome in endogenous endophthalmitis.

Sphingomonas paucimobilis endophthalmitis postpenetration ocular trauma: A rare case report.

Endophthalmitis is an uncommon purulent inflammation of the intraocular fluids secondary to endogenous or exogenous causes. It is known that posttraumatic endophthalmitis had a notably poor visual outcome, and it poses therapeutic challenges. Therefore, early organism detection would be beneficial in therapeutic management and are able to reduce long-term complications. This case report describes a patient with a rare positive culture-proven Sphingomonas paucimobilis endophthalmitis due to penetrating ocular trauma by a metal brush over the right eye. A 36-year-old man presented with progressively worsening right eye redness and blurring of vision with pain for 3 days following ocular penetration by a metal brush during grinding. On initial presentation, his visual acuity was 6/12 over the right eye and 6/6 over the left eye. His visual acuity deteriorated to hand movement 5 days later with worsening of ocular infection over the right eye despite topical and oral antibiotics. B-scan revealed dense vitreous infiltration. A vitreous tap was done, and a combination of intravitreal vancomycin and ceftazidime was administered. Vitreous culture isolated Gram negative S. paucimobilis. The patient was planned for early vitrectomy; however, the patient opted for conservative treatment. Therefore, the patient received intravitreal vancomycin and intravitreal ceftazidime injections every 48-72 h. Published articles on S. paucimobilis endophthalmitis postocular penetration are extremely limited. This case report may provide a better understanding of the presentation and is able to aid with early diagnosis and treatment initiation for future reference.

A Rare Occurrence of Isolated Endogenous Escherichia coli Panophthalmitis: A Case Report.

Panophthalmitis is a severe ocular condition that can lead to devastating outcomes, such as evisceration, if not promptly treated. It typically originates endogenously, with urinary tract infection being a common primary source of infection. This report describes a rare case of a 61-year-old Malay patient with left eye panophthalmitis. Ocular culture revealed Escherichia coli, while systemic septic workup yielded negative results. Due to the severity of the ocular condition at presentation and the disproportionate level of pain the patient had, an immunocompromised state was suspected and later the diagnosis of diabetes mellitus was confirmed via laboratory investigation. Despite the delay in presentation, which hindered early intervention, the patient's eyeball was successfully salvaged through a treatment regimen involving three injections of intravitreal antibiotic administered at 48 to 72-hour intervals and a complete course of intravenous antibiotics. This case report highlights the importance of prompt treatment to salvage an eye from evisceration in the case of panophthalmitis.