Visual and Anatomical Outcomes of Microbial Keratitis-Induced Endophthalmitis

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Purpose To examine the incidence, clinical features, causative pathogens, treatment approaches, and outcomes of microbial keratitis (MK)-induced endophthalmitis.Methods Retrospective analysis of all cases of MK-induced endophthalmitis over a period of 10 years (2008–2018). Details regarding clinical presentation, medical and surgical intervention, outcomes, culture results, and antibiotic susceptibility were collected. Univariate analysis was performed to obtain p values described in the study.Results Of 491 endophthalmitis cases, 30 (6.12%) were associated with MK. The mean age (± standard deviation) was 52.7 ± 27.1 years. Gram-positive bacteria (92.3%) were the most common isolates. At presentation, the median best-corrected visual acuity (BCVA) was light perception. Treatment included intravitreal antibiotics in all cases. In some cases (40%), vitrectomy, therapeutic keratoplasty, or amniotic membrane transplantation was performed. At 1 year, the median BCVA was hand motion, with only 16.7% of eyes achieving a BCVA of 20/200 or better. Eyes with secondary keratitis (associated with previous surgery) had significantly better visual outcomes at 12 months compared to those with primary keratitis (p = 0.008). Evisceration was performed in 13.3% of the cases.Conclusion While diagnosing endophthalmitis in eyes with microbial keratitis can be challenging, B-scan ultrasonography was an effective diagnostic tool. The visual outcome is usually poor, especially in Staphylococcus epidermidis infected eyes and primary keratitis.