Temporal B-Scan Ultrasonography Findings and their Relation to Visual Outcomes in Endophthalmitis

Purpose: To evaluate B-scan echographic features of endophthalmitis for their correlation with disease characteristics and long-term vision outcomes. Methods: Patients diagnosed with endophthalmitis at Massachusetts Eye and Ear between 2011 and 2021 were recruited (N = 209). Data included demographics, infection source, initial therapy, and findings from culture isolates, best corrected visual acuity (BCVA), slit lamp, and B-scan ultrasonography. Results: More patients with positive microbial cultures, versus those with negative cultures, had dense vitreous debris on initial B-scan ( P = .008). Patients whose initial slit lamp examination provided difficult/no view into the anterior chamber had more frequent findings of retinal detachment (RD) and T-sign ( P < .001 and P = .016, respectively) and worse final mean BCVA ( P < .001) versus patients with adequate views. Patients with dense vitreous opacities (VO) on initial B-scan had significantly worse initial mean BCVA versus patients with mild or moderate VO ( P < .001 and P = .013, respectively) and had significantly worse final mean BCVA versus patients with mild VO ( P < .001). Final mean BCVA was significantly worse in patients with choroidal detachment (CD), RD, or T-sign than in patients without these features (each P < .001). Reductions in VO and vitreous membranes were observed at 1 month postpresentation, whereas CD was significantly more common at 1 week and RD more common at 1 month postpresentation. Conclusions: Positive cultures, specific microbial species, and B-scan findings (dense VO, CD, RD, and T-sign) are independent predictors of worse vision outcomes in patients with endophthalmitis.