Clinical profile and outcomes of endogenous endophthalmitis at the University of the Philippines-Philippine General Hospital: an eight-year retrospective study.

objectivesTo describe the clinical profile and outcomes of patients diagnosed with endogenous endophthalmitis at a national university hospital in the Philippines.

methodsThis single-center, 8-year retrospective, cross-sectional chart review examined the medical records of patients clinically diagnosed with endogenous endophthalmitis at the Philippine General Hospital Department of Ophthalmology and Visual Sciences from January 1, 2017 to December 31, 2024. The data included were patient demographics, clinical presentation, initial and final best corrected visual acuity, microbiological profile of intraocular and systemic infections, and management performed.

resultsTwenty-seven eyes of 25 patients were included in the study. The mean age was 50.2 ± 14.7 years old with majority (36%) of the patients in the 51-60 years-old age range. There was a slight male predilection (60%). Twenty-three patients had unilateral disease, while 2 patients had bilateral disease. The mean duration from symptom onset to consult was 10.1 ± 8.8 days and the mean duration of follow-up was 5.4 ± 4.6 months. The most common presenting symptoms were blurred vision (93%), eye redness (85%), and eye pain (70%). The most common presenting signs were vitritis (93%), absence of fundus view and anterior chamber inflammation (85%), and conjunctival injection (74%). Majority of patients (33%) had an initial best corrected visual acuity of hand movement. The most common risk factors identified were diabetes (64%), sepsis (32%), and chronic kidney disease (28%). The culture positivity rate was 44% for both intraocular and systemic cultures. The most common organism isolated from intraocular cultures (vitreous) was Klebsiella pneumoniae and the most common organism isolated from systemic cultures was Staphylococcus aureus, with majority without identified extraocular foci of infection at 48%. Among systemic cultures, Gram-positive organisms were usually seen in the setting of sepsis while Gram-negative organisms were all isolated from the urinary tract. Majority (56%) underwent pars plana vitrectomy as the primary management performed but the final best corrected visual acuity was most commonly no light perception (52%). Only 7% of patients had a final visual acuity better than counting fingers.

conclusionEndogenous endophthalmitis is a severe disease with devastating consequences. Despite timely diagnosis and management, majority of patients still end up with poor nonfunctional vision. Gram-negative microorganisms are the most common etiologic agents of endogenous endophthalmitis consistent with studies in East Asia. However, none of the patient in this study had documented liver pathology.