When Lightning Strikes Twice: Recurrent Endophthalmitis

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Investigative Ophthalmology & Visual Science


Purpose : Infectious endophthalmitis is devastating, yet exceptionally rare complication following ocular surgery, procedures, trauma, and systemic illnesses. Numerous studies have documented the etiologies, risk factors, clinicopathologic features, treatment algorithms, and outcomes following endophthalmitis. Despite its rarity, few patients will have more than one episode of infectious endophthalmitis in their lifetime. Therefore, we reviewed those patients who were diagnosed and treated for two separate episodes of endophthalmitis

Methods : A retrospective, consecutive case series was conducted on patients managed at Associated Retinal Consultants P.C. (Royal Oak, Michigan, USA) from January 2013 to September 2019. Patients were identified with endophthalmitis by ICD-9/10 codes on two separate encounters at least 90 days apart. Those that were diagnosed and treated with either a vitreous tap/intravitreal injection of antibiotics or pars plana vitrectomy at least two times were included. Those with persistent infectious endophthalmitis were excluded.

Results : A total of 296 patients were reviewed and 12 patients met inclusion criteria. The median age at presentation at initial 75.9 with 33.3% being male. Nine of the 12 (75%) patients had repeat endophthalmitis involving the same eye, whereas 3 (25%) had separate episodes in different eyes. The average time between episodes was 604 days (range 79-2369 days). The average follow up from the second episode was 502 days (range 87 – 1157 days). The most common etiology for both first and second episode, respectively was intravitreal injection (50% and 58.3%) followed by post-surgical (41.6% and 33.3%). Eight patients (75%) had an identical etiology between their first and second episode. Of the 24 recorded episodes of endophthalmitis cultures were positive in 41.6% with coagulase-negative Staphylococcus being the most common. Those with same eye disease had progressively worse visual outcomes after each subsequent episode from a mean LogMAR (SD) at presentation of 0.28 (0.08) to 0.50 (0.14) after the first episode to 0.78 (0.30) at final follow-up.

Conclusions : An intravitreal injection was the most common etiology of recurrent endophthalmitis. The majority of cases were culture negative. Each episode of endophthalmitis is associated with a worse final visual outcome.





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