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BACTERIAL KERATITIS AND ASSOCIATED ENDOPHTHALMITIS

BACTERIAL KERATITIS AND ASSOCIATED ENDOPHTHALMITIS. Dermot Cassidy FRANZCO, Paul Connell FRCSI, Penelope Allen FRANZCO, Rasik Vajpayee MS, FRCS(Edin ), FRANZCO Royal Victorian Eye and Ear Hospital, Melbourne, Australia.

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BACTERIAL KERATITIS AND ASSOCIATED ENDOPHTHALMITIS

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  1. BACTERIAL KERATITIS AND ASSOCIATED ENDOPHTHALMITIS Dermot Cassidy FRANZCO, Paul Connell FRCSI, Penelope Allen FRANZCO, Rasik Vajpayee MS, FRCS(Edin), FRANZCO Royal Victorian Eye and Ear Hospital, Melbourne, Australia The authors have no financial interest in the subject matter of this poster

  2. Introduction • Endophthalmitis is a rare but potentially blinding condition • The published literature contains a paucity of data regarding cases of microbial keratitis associated with endophthalmitis

  3. Aims To investigate cases of bacterial keratitis associated with endophthalmitis for - • Potential risk factors • Microbiological profiles • Visual acuity outcomes

  4. Methodology • Retrospective case series • All cases treated for bacterial keratitis and coexisting endophthalmitis over a 10-year period at a tertiary referral eye hospital (RVEEH) • Endophthalmitis defined as: • Positive intraocular culture or posterior segment inflammation on clinical or histological examination

  5. Results • 23 cases were identified • Mean age 72 years (range 46 – 92) • 12 males, 11 females

  6. Results – Ocular Associations 17 eyes (73.9%) had significant pre-existing ocular pathology • Ischaemic CRVO (6) • Penetrating Keratoplasty (5) • Recurrent corneal ulceration (1) • Ocular Trauma (2) • Proliferative diabetic retinopathy (1) • Phacomorphic glaucoma (1) • Neurotrophic cornea (1)

  7. Results – Systemic Associations • Chronic intellectual impairment 39% (9) • Diabetes mellitus 8% (2) • Exogenous immunosuppresion 4% (1)

  8. Results – Microbiological profile 83% (19) of cases yielded a positive culture • Of these, corneal scraping yielded a positive culture in 16 of the 19 cases • A polymicrobial culture result was found in 3 cases (16%)

  9. Results – Microbiological profile Isolated organisms: • Pseudomonas aeruginosa - 47% (9) • Streptococcal spp - 37% (7) • Staphylococcus aureus - 18% (3) • Propionibacterium acnes - 5% (1) • Enterococcus spp - 5% (1)

  10. Results – Visual Outcomes Cases demonstrate a poor visual prognosis: • Vision at presentation – HM or less in all patients • Final Vision - 22 of 23 eyes (96%) were enucleated or eviscerated • Median time to enucleation 4 days • Mean time to enucleation 6.6 days

  11. Conclusions In our series, cases of bacterial keratitis and associated endophthalmitis demonstrate: • High proportion of significant pre-existing ocular pathology and cognitive impairment • High incidence of virulent organisms • Very poor visual prognosis

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