Endogenous endophthalmitis in a tertiary centre of northern Malaysia: a case series and literature review

Background: Endogenous endophthalmitis is an uncommon ophthalmological emergency caused by hematogenous spread of infection from a distant focus. It can lead to permanent blindness, panophthalmitis, enucleation, or evisceration. Difficulties are often encountered in making a diagnosis, yielding cultures of causative pathogens and selecting appropriate antibiotics. Case series: We describe 4 cases treated in Hospital Sultanah Bahiyah from 2021 to 2022. The studied cases belonged to a high-risk group in common with at least 1 predisposing medical condition. Endogenous endophthalmitis was caused by different etiologies and demonstrated various clinical manifestations. Two patients were initially misdiagnosed and later referred to our centre. The identified pathogens were predominantly Gram-negative bacteria, i.e., Klebsiella variicola and Pseudomonas aeruginosa. Magnetic resonance imaging was utilized in 1 patient to help distinguish an infection from a metastatic carcinoma. All patients received intravitreal antibiotics. Two patients underwent vitreoretinal surgery and were able to achieve 2/60 or better postoperatively. One patient required evisceration and another developed phthisis bulbi. Conclusion: Aggressive screening for occult infection is important to identify the source of infection and guide appropriate antibiotic treatment. Early diagnosis and prompt antimicrobial treatment are crucial to prevent devastating complications.