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Vitreoretinal surgery
Impact of microorganism virulence on endophthalmitis outcomes
  1. Aaron Yap1,
  2. Dilpreet Kaur1,
  3. Sharmini Muttaiyah2,
  4. Sarah Welch3,
  5. Sue Lightman4,
  6. Oren Tomkins-Netzer4,5,
  7. Rachael L Niederer1,3
  1. 1The University of Auckland Department of Ophthalmology, Auckland, New Zealand
  2. 2Department of Microbiology, Auckland District Health Board, Auckland, New Zealand
  3. 3Ophthalmology, Auckland District Health Board, Auckland, New Zealand
  4. 4Department of Ophthalmology, Moorfields Eye Hospital, London, UK
  5. 5Department of Ophthalmology, UCL Institute of Ophthalmology, London, UK
  1. Correspondence to Dr Rachael L Niederer; eye-health{at}outlook.com

Abstract

Aims To determine the impact of microorganism virulence on visual outcomes in endophthalmitis.

Methods Retrospective, multicentre cohort study of patients presenting with endophthalmitis between 2006 and 2021. A literature review was conducted to divide cultured microorganisms into low and high virulence subcategories.

Results 610 eyes with endophthalmitis were recruited from New Zealand, the UK and Israel. The median age was 69.4 years. The median visual acuity was hand movements at presentation and 20/120 at the final follow-up. Severe visual loss (≤20/200) occurred in 237 eyes (38.9%) at the final follow-up. The culture-positive rate was 48.5% (296 eyes). Highly virulent microorganisms were associated with a 4.48 OR of severe visual loss at the final follow-up (p<0.001) and a 1.90 OR of developing retinal detachment or requiring enucleation or evisceration during the follow-up period (p=0.028). Oral flora were observed in 76 eyes (25.7%), and highly virulent microorganisms were observed in 68 eyes (22.9%). Highly virulent microorganisms were more likely to be found after glaucoma surgery (15 eyes, 34.9%) and vitrectomy (five eyes, 35.7%) compared with intravitreal injections (two eyes, 2.9%) and cataract surgery (22 eyes, 24.2%). On multivariate analysis, the following were associated with poorer visual outcomes: poor presenting vision (p<0.001), glaucoma surgery (p=0.050), trauma (p<0.001), oral microorganism (p=0.001) and highly virulent microorganism (p<0.001).

Conclusion This is the first classification of microorganisms into high and low virulence subcategories that demonstrate highly virulent microorganisms were associated with poor visual outcomes and increased likelihood of retinal detachment and enucleation.

  • Infection
  • Microbiology
  • Vitreous

Data availability statement

Data are available upon reasonable request.

https://doi.org/10.1136/bjo-2024-325605

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • Contributors AY: writing—original draft, writing—review and editing. DK: conceptualisation, data curation, investigation, methodology; project administration, writing—original draft; writing—review and editing. SM: investigation; review and editing. SW: writing—review and editing. SL: review and editing. OT-N: data curation; writing—review and editing. RN (guarantor): conceptualisation, methodology, formal analysis, supervision, writing—review and editing. RN is the guarantor.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.