Clinical Course and Characteristics of Eyes that Developed Recurrent Episodes of Endophthalmitis.

Abstract Purpose Infectious endophthalmitis is a devastating, yet rare complication following intraocular surgery, trauma, and systemic illness. Given its rare incidence, few patients would be expected to have more than one episode of infectious endophthalmitis in their lifetime. We reviewed our patients who were diagnosed with, and treated for, at least two separate episodes of endophthalmitis. Design A retrospective, consecutive case series was conducted of patients managed at Associated Retinal Consultants P.C. (Royal Oak, Michigan) from January 2013 thru December 2019. Subjects Patients were identified with the diagnosis of endophthalmitis by ICD-9/10 codes. Methods: Those diagnosed and then treated with either a vitreous tap/intravitreal injection of antibiotics or pars plana vitrectomy at least two times were included. Those treated multiple times for the same episode of endophthalmitis were excluded. Main Outcome Measures Etiology and risk factors for recurrent endophthalmitis. Results Charts of 535 patients were reviewed and 12 patients met inclusion criteria. The median age at initial presentation was 72.5 years and 33.3% were men. Eight of the 12 (66%) patients had recurrent endophthalmitis in the same eye and 4 (33%) had separate episodes in different eyes. The average time between episodes was 604 days (range 90-2366 days). The average follow-up from the second episode was 492 days (range 119 – 1185 days). The most common etiology for both the first and second episode was recent intravitreal injection (50% and 58.3%) followed by surgery-associated (41.6% and 33.3%). Eight patients (75%) had the same etiology for their first and second episodes. Of the 24 recorded episodes of endophthalmitis, cultures were positive in 41.6% with coagulase-negative Staphylococcus being the most common bacteria identified. Conclusions Recurrent endophthalmitis is rare and most commonly seen after intravitreal injections. The majority of cases in this series were culture negative. Each successive episode of endophthalmitis was associated with a worse final visual outcome. The cumulative number of intravitreal injections may be an independent risk factor for recurrent post-injection endophthalmitis.