ENDOPHTHALMITIS CAUSED BY ENTEROCOCCUS FAECALIS

Abstract

In Brief Background: To profile the etiology, clinical features, visual and anatomical outcomes in eyes diagnosed with Enterococcus faecalis endophthalmitis. Methods: A single (tertiary care) center, Retrospective interventional case series. Clinical and microbiological records of 26 consecutive eyes with culture positive E. faecalis endophthalmitis treated at a tertiary referral ophthalmic hospital in south India from 1st January 1995 to September 2007 were reviewed and analyzed. Results: Of the twenty-six eyes, 12 were of postsurgical etiology, 11 cases were posttraumatic while 3 were of endogenous causes. Two eyes had an intraocular foreign body. Initial mean visual acuity was 3.19 logMAR (range: 0.77–4). All cases were treated with vitrectomy and intravitreal injections. Six cases developed retinal detachment after initial surgery, but only 30.7% eyes had a poor anatomical outcome (8 patients out of 26). All cases except one were sensitive to Vancomycin. Final mean visual acuity was 2.12 logMAR (range: 0.17–4). Paired ‘t’ test showed statistically significant (P = 0.008) good visual outcome (better than or equal to 3/60). Conclusions: Surgery (12 of 26 eyes) and trauma (11 of 26 eyes) were the commonest causes of E. faecalis endophthalmitis. Our results indicate that early surgical intervention can lead to a good functional outcome despite the virulent nature of the organism. Since almost all the cases were sensitive to Vancomycin, it may be considered as a first line drug in the management of such eyes. Enterococci are important cause of postoperative endophthalmitis associated with the worst visual sequelae among all causes of endophthalmitis. This series documents the profile and management of Enterococcus faecalis endophthalmitis. Results reemphasize the need of early intervention and the usefulness of Vancomycin in management of endophthalmitis due to a virulent organism like Enterococcus faecalis.