Transcript ONE INTO TWO Efficient use of scarce resources

BACTERIAL KERATITIS AND
ASSOCIATED ENDOPHTHALMITIS
Dermot Cassidy FRANZCO, Paul Connell FRCSI,
Penelope Allen FRANZCO, Rasik Vajpayee MS,
FRCS(Edin), FRANZCO
Royal Victorian Eye and Ear Hospital,
Melbourne, Australia
The authors have no financial interest in the subject matter of this poster
Introduction
• Endophthalmitis is a rare but potentially
blinding condition
• The published literature contains a paucity
of data regarding cases of microbial
keratitis associated with endophthalmitis
Aims
To investigate cases of bacterial keratitis
associated with endophthalmitis for • Potential risk factors
• Microbiological profiles
• Visual acuity outcomes
Methodology
• Retrospective case series
• All cases treated for bacterial keratitis and
coexisting endophthalmitis over a 10-year
period at a tertiary referral eye hospital
(RVEEH)
• Endophthalmitis defined as:
– Positive intraocular culture or posterior segment
inflammation on clinical or histological examination
Results
• 23 cases were identified
• Mean age 72 years (range 46 – 92)
• 12 males, 11 females
Results – Ocular Associations
17 eyes (73.9%) had significant pre-existing
ocular pathology
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Ischaemic CRVO (6)
Penetrating Keratoplasty (5)
Recurrent corneal ulceration (1)
Ocular Trauma (2)
Proliferative diabetic retinopathy (1)
Phacomorphic glaucoma (1)
Neurotrophic cornea (1)
Results – Systemic Associations
• Chronic intellectual impairment 39% (9)
• Diabetes mellitus 8% (2)
• Exogenous immunosuppresion 4% (1)
Results – Microbiological profile
83% (19) of cases yielded a positive culture
• Of these, corneal scraping yielded a positive
culture in 16 of the 19 cases
• A polymicrobial culture result was found in 3
cases (16%)
Results – Microbiological profile
Isolated organisms:
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Pseudomonas aeruginosa - 47% (9)
Streptococcal spp - 37% (7)
Staphylococcus aureus - 18% (3)
Propionibacterium acnes - 5% (1)
Enterococcus spp - 5% (1)
Results – Visual Outcomes
Cases demonstrate a poor visual prognosis:
• Vision at presentation – HM or less in all
patients
• Final Vision - 22 of 23 eyes (96%) were
enucleated or eviscerated
– Median time to enucleation 4 days
– Mean time to enucleation 6.6 days
Conclusions
In our series, cases of bacterial keratitis and
associated endophthalmitis demonstrate:
• High proportion of significant pre-existing
ocular pathology and cognitive impairment
• High incidence of virulent organisms
• Very poor visual prognosis