Treatment outcomes after pars plana vitrectomy for endogenous endophthalmitis

Purpose: To evaluate the causative organisms of and predisposing medical conditions in endogenous endophthalmitis and review visual acuity after pars plana vitrectomy. Methods: Records of 23 patients (32 eyes) who were diagnosed with endogenous endophthalmitis and treated at Shanghai Eye, Ear, Nose & Throat-Hospital from January 2000 to December 2003 were retrospectively reviewed. Final visual acuity was followed up. Results: Of these 23 patients, 19 (86%) had endogenous endophthalmitis confirmed with a positive smear or culture; 12 cases (63%) were due to fungi, 6 (32%) were due to bacteria, and 1 (5%) was a mixed infection (fungus and bacteria). Culture specimens from four patients, which were obtained by vitrectomy, were all positive, while their initial vitreous needle biopsy specimens were negative. Of the 20 eyes that underwent pars plana vitrectomy, 17 (85%) had anatomical success, and 16 (80%) gained visual acuity of counting fingers or better; of these eyes, 8 (40%) had visual acuity of 20/200 or better. Conclusion: Fungi, especially Candida albicans, were the most common causative organisms. The most common predisposing medical conditions were recent tumor surgery and intravenous administration in rural settings. Most patients with endogenous endophthalmitis who undergo pars plana vitrectomy will have useful vision (counting fingers). Vitreous specimens for culture that were obtained by vitrectomy were more sensitive in detecting the causative organism.