Clinical features, microbiological profiles, and prognostic factors of endogenous endophthalmitis: a 20-year retrospective study in Northern China

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This 20-year retrospective study analyzed the clinical features, microbiological profiles, and prognostic factors of 120 eyes from 103 patients with endogenous endophthalmitis (EE) at a tertiary referral center in Northern China. Most patients presented with vision loss (96.1%), eye pain (51.0%) and eye redness (45.1%). Systemic symptoms were observed in 56 cases (54.4%) including fever (47.6%) and chills (14.6%). Diabetes (24.3%) and urinary calculi (7.8%) were predominant risk factors. Liver abscesses (29.1%) and urinary tract infections (8.7%) were the most common infection sources. Klebsiella pneumoniae (58.7%) and Candida albicans (19.6%) were the most frequent pathogens. Primary surgical interventions included vitrectomy (55.1%) and intravitreal injections (29.6%). Vitrectomy was significantly associated with better final visual outcomes compared to intravitreal injection alone ( χ² = 11.942, p = 0.018). Final visual acuity (VA) ≥ 20​/200 was achieved in 22.9%, while 29.2% had no light perception. Initial VA was the only factor associated with poor visual outcomes ( p = 0.019; OR 6.112; 95% CI 1.354–27.584). Enucleation/evisceration (15.0%) was linked to Gram-negative infections ( p = 0.041). These findings underscore that EE remains a vision-threatening condition in Northern China, where early surgical intervention and multidisciplinary management are crucial, we emphasize that comprehensive urological evaluation should be routinely integrated alongside standard abdominal screening to ensure prompt identification of systemic infectious foci.