BACTERIAL KERATITIS AND BACTERIAL KERATITIS AND ASSOCIATED ASSOCIATED

ENDOPHTHALMITISENDOPHTHALMITIS

Dermot Cassidy FRANZCO, Paul Connell Dermot Cassidy FRANZCO, Paul Connell FRCSI, Penelope Allen FRANZCO, Rasik FRCSI, Penelope Allen FRANZCO, Rasik

Vajpayee MS, FRCS(Edin), FRANZCOVajpayee MS, FRCS(Edin), FRANZCO

Royal Victorian Eye and Ear Royal Victorian Eye and Ear Hospital, Melbourne, AustraliaHospital, Melbourne, Australia

The authors have no financial interest in the subject matter of this posterThe authors have no financial interest in the subject matter of this poster

IntroductionIntroduction

• Endophthalmitis is a rare but potentially blinding condition

• The published literature contains a paucity of data regarding cases of microbial keratitis associated with endophthalmitis

AimsAims

To investigate cases of bacterial keratitis

associated with endophthalmitis for -• Potential risk factors• Microbiological profiles• Visual acuity outcomes

MethodologyMethodology

• 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

ResultsResults

• 23 cases were identified• Mean age 72 years (range 46 – 92)

• 12 males, 11 females

Results – Ocular AssociationsResults – Ocular Associations

17 eyes (73.9%) had significant pre-existingocular pathology

• 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 Results – Systemic AssociationsAssociations

• Chronic intellectual impairment 39% (9)

• Diabetes mellitus 8% (2)• Exogenous immunosuppresion

4% (1)

Results – Microbiological Results – Microbiological profile 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 Results – Microbiological profile profile

Isolated organisms: • Pseudomonas aeruginosa - 47% (9)• Streptococcal spp - 37% (7)• Staphylococcus aureus - 18% (3)• Propionibacterium acnes - 5% (1)• Enterococcus spp - 5% (1)

Results – Visual OutcomesResults – 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

ConclusionsConclusions

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