Endogenous endophthalmitis complicating infective endocarditis: a multicenter case series

Introduction Endogenous endophthalmitis (EE) is a rarely reported complication of infective endocarditis (IE). In an international series, we sought to determine the clinical and microbiological profile, treatment and outcome of patients presenting with IE-related EE. Methods Cases of EE recorded from 2014 to 2023 in 9 centers in Europe and the United States were collected. Results were compared to a matched control group. Results Sixty-six patients with EE were reported, mean age 65.2± 14.9 years, 71% (n=47) male. Blood cultures were positive in 90% (60 cases) of patients, with a predominance of streptococci (46%, n=30). As compared with the control group (n=264), the EE group presented with more frequent diabetes (34vs 20%, p=0.02), history of cirrhosis (9 vs 3%, p=0.04), glomerulonephritis (15 vs 0.3%, p<0.001), embolism before admission (92 vs 55%, p<0.001), and Janeway lesions (9 vs 1%, p=0.002). Streptococcal infection (46 vs 26%, p= 0.003) was more frequent and enterococcal infection (0 vs 18%, p< 0.001) less frequent in the EE group. The main ocular symptoms were a decrease in visual acuity (96%), red eye (55%) and ocular pain (55%). Treatment of EE consisted of intravitreal antibiotic injection in 55 (83%) patients and vitrectomy in 17 (26%). Improvement of visual acuity was observed in 36 (55%) patients but 43 (65%) still experienced severe impairment at one-year with 20 (30%) patients classified as legally blind. Conclusion EE is a serious complication of IE with severe residual vision impairment. Patients with IE should be evaluated for ocular complications, since early detection of EE is crucial to prevent delays in management and to preserve visual function.Severe endogenous endophthalmitis Endophthalmitis versus control group