Pillai Gopal S, Remadevi Kiran Krishnankutty, Anilkumar V, Radhakrishnan Natasha, Rasheed Rehna, Ravindran Greeshma C
Department of Ophthalmology, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India.
Department of Microbiology, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India.
Indian J Ophthalmol. 2020 May;68(5):827-833. doi: 10.4103/ijo.IJO_948_19.
The purpose of this study is to evaluate the clinical profile, visual, anatomical and survival outcome of patients with endogenous endophthalmitis.
Retrospective chart review of consecutive cases with endogenous endophthalmitis presenting from 2009-2016.
In our study, 41 eyes of 34 patients were included. Most common co-morbidity associated with endogenous endophthalmitis was Diabetes Mellitus (70.7%) and most common infective foci was UTI (73.2%). Among the culture positive cases, fungi and bacteria were evenly distributed, 76.93% were Gram positive bacteria and 23.07% were Gram negative. Fungal endogenous endophthalmitis was more commonly seen in immunosuppressed state (72.7%) and bilateral cases (66.7%). The mean presenting vision (log MAR) of patients who died during the study were poor compared to those who survived (P = 0.014) Poor mean visual acuity at presentation was associated with more death (P = 0.014). Eyes with poor presenting vision, fungal isolates, culture positivity and immune suppression had poor visual and survival outcome. Poor visual outcome was observed more frequently in eyes with Aspergillus infection (85.7%) compared to Candida (75%) and bacteria (58.3%). Evisceration was done for 5 out of 41 eyes (12.2%). Vitrectomy rate was 53.7% in our study, with 40% of them showing overall improvement in vision.
Endogenous endophthalmitis is a sight threatening condition associated with high mortality particularly when caused by Aspergillus spp. in immunocompromised patients. Contrary to the prior published reports of endogenous endophthalmitis outside India, we found an equal distribution of fungal and bacterial organisms among our cases, with predominance of Aspergillus among fungal isolates and Gram-positive organism among bacteria. Fungal infections, especially with Aspergillus spp., resulted in poor visual and survival outcome.
本研究旨在评估内源性眼内炎患者的临床特征、视力、解剖结构及生存结局。
对2009年至2016年连续收治的内源性眼内炎病例进行回顾性病历分析。
本研究纳入了34例患者的41只眼。与内源性眼内炎相关的最常见合并症是糖尿病（70.7%），最常见的感染灶是尿路感染（73.2%）。在培养阳性病例中，真菌和细菌分布均匀，76.93%为革兰氏阳性菌，23.07%为革兰氏阴性菌。真菌性内源性眼内炎在免疫抑制状态（72.7%）和双侧病例（66.7%）中更常见。与存活患者相比，研究期间死亡患者的初始视力（对数最小分辨角）较差（P = 0.014）。初始视力差与更多死亡相关（P = 0.014）。初始视力差、真菌分离株、培养阳性及免疫抑制的眼，其视力和生存结局较差。与念珠菌感染（75%）和细菌感染（58.3%）的眼相比，曲霉菌感染的眼视力预后差更为常见（85.7%）。41只眼中有5只（12.2%）行眼内容剜除术。本研究中玻璃体切割率为53.7%，其中40%的患者视力总体改善。
内源性眼内炎是一种威胁视力的疾病，死亡率高，尤其是在免疫功能低下患者中由曲霉菌属引起时。与印度以外先前发表的内源性眼内炎报告相反，我们发现本病例中真菌和细菌病原体分布均匀，真菌分离株中曲霉菌占优势，细菌中革兰氏阳性菌占优势。真菌感染，尤其是曲霉菌属感染，导致视力和生存结局较差。
