This article is more than 5 years old. Information may no longer be current.
Streptococcal endophthalmitis leads to high rate of vision loss
Click Here to Manage Email Alerts
Streptococcal endophthalmitis is a virulent and potentially devastating infection with a poor visual prognosis. This was confirmed by a study carried out in a large university referral center in Thailand, where 45 out of 411 patients with infectious endophthalmitis were culture positive for Streptococcus. The most common isolates were Streptococcus pneumoniae at 44.44%, group B beta-hemolytic Streptococcus at 26.68% and Streptococcus viridans at 20%.
The main cause of endophthalmitis in this cohort was intraocular surgery, mainly cataract surgery, in 16 patients (35.56%). Nine patients (20%) developed the infection after penetrating ocular injury from twigs, nails or bird pecking. Seven patients (15.56%) had endogenous endophthalmitis, two (4.44%) had keratitis-associated disease, and one (2.22%) had bleb-related infection.
Vision at presentation ranged from hand motion to no light perception in the majority of cases. Most patients were treated by pars plana vitrectomy, either with intravitreal antibiotics or with silicone oil tamponade.
Visual acuity improved in only nine patients, five of which achieved 6/60 or better. Most patients had poor visual outcomes. Twenty-four had no light perception, and 15 with painful eyes eventually underwent evisceration or enucleation.
The only significant prognostic factor for better visual outcomes was early vitrectomy, within 3 days of presentation.
“Early diagnosis and early vitrectomy are therefore recommended,” the authors wrote.
“This study confirms the results of other previous studies that streptococcal endophthalmitis is often associated with poor visual prognosis, and the rate of eye removal was high. The key success factors depend on early diagnosis and prompt surgical intervention. Rapid microbiological investigation such as polymerase chain reaction can help ophthalmologists identify streptococcus early and make earlier treatment decisions, as well as advise the patients on their visual prognosis. Early vitrectomy, done within 3 days, was associated with the most favorable visual outcomes,” Yosanan Yospaiboon, MD, first author of the study, told Healio.com/OSN. – by Michela Cimberle
Disclosures: The authors report no relevant financial disclosures.
Click Here to Manage Email Alerts