Endophthalmitis: Epidemiology, Causing Agents, Therapy and Visual Outcome with Special Focus on Glaucoma Patients

Background Endophthalmitis is one of the most serious emergencies in ophthalmology. In order to reduce its prevalence, it is important to have a proper understanding of potential risk. Surgical therapy with targeted, pathogen-specific medication and an intact immune system are fundamental for preserving visual acuity. As it is unclear whether an unfavourable course is more likely in the presence of underlying ocular disease, a comparison was made between glaucoma patients (G) and non-glaucoma patients (NG) in terms of causative factors, pathogens, treatment and visual acuity. Since a potential alteration of the local immune system in glaucoma has been described, it is of interest to determine whether the clinical course of endophthalmitis in glaucoma patients differ from that of non-glaucoma patients. Patients and Methods A retrospective analysis of 75 eyes (13 G, 62 NG) who underwent treatment and surgery following a diagnosis of endophthalmitis in the Department of Ophthalmology, University of Erlangen-Nuremberg has been evaluated over a period of 5 years. Clinical characteristics, surgical treatment, microbial spectrum and visual acuity in glaucoma and non-glaucoma eyes were investigated. Results Severe visual impairment (44%) with inflammation of the anterior chamber (62.7%), hypopyon (52%) and reduced (40%) or absent view (26.7%) of the fundus were predominantly present at first diagnosis in all patients. Previous eye surgery was observed in a total of 53%, primarily cataract surgery. Gram-positive cocci were seen as the most common causative agent in both groups, (G: 23.1%; NG: 38.7%), whereas other rare pathogens were present only in glaucomatous eyes. Pars plana vitrectomy was performed in 76% and enucleations in 20% of all patients, with the latter significantly more common in glaucomatous eyes (p = 0.01). A significant postoperative improvement in visual acuity was achieved in non-glaucoma patients (p < 0.001); visual acuity was worse in glaucomatous eyes. Conclusion Although rare, early diagnosis and treatment of endophthalmitis is crucial in terms of prognosis. In the present cohort, worse visual acuity outcomes were obtained in glaucoma patients in comparison to non-glaucoma patients.