Result of early vitrectomy for endogenous Klebsiella pneumoniae endophthalmitis

• Published in: Retina (Philadelphia, Pa.) Vol. 23; no. 3; p. 366
• Main Authors: Yoon, Young H, Lee, Sang U, Sohn, Joon-Hong, Lee, Song E
• Format: Journal Article
• Language: English
• Published: United States 01.06.2003
• Subjects: Adult; Aged; Anti-Bacterial Agents; Drug Therapy, Combination - therapeutic use; Endophthalmitis - drug therapy; Endophthalmitis - microbiology; Endophthalmitis - surgery; Eye Infections, Bacterial - drug therapy; Eye Infections, Bacterial - microbiology; Eye Infections, Bacterial - surgery; Female; Humans; Klebsiella Infections - drug therapy; Klebsiella Infections - microbiology; Klebsiella Infections - surgery; Klebsiella pneumoniae - isolation & purification; Liver Abscess - microbiology; Male; Middle Aged; Retrospective Studies; Sepsis - microbiology; Treatment Outcome; Vitrectomy - methods; Vitreous Body - microbiology
• ISSN: 0275-004X
• DOI: 10.1097/00006982-200306000-00013

To determine the role of pars plana vitrectomy (PPV) in the treatment of Klebsiella pneumoniae endogenous endophthalmitis. Records of seven consecutive patients (10 eyes) diagnosed with Klebsiella endogenous endophthalmitis were retrospectively reviewed. Five patients (71%) had diabetes, and four (57%) had a liver abscess as the source. In most cases, the inflammation progressed within days and resulted in decreased vision worse than hand motions and a total vitreous abscess, despite systemic and intravitreal antibiotic injections. A PPV with subretinal abscess drainage and silicone oil tamponade was performed within 2 weeks. After 6 months, the retina remained attached in all eyes (100%), and vision was counting fingers or better in five eyes (50%). Two eyes recovered visual acuity between 20/63 and 20/125. Physicians should be alerted to the development of endogenous endophthalmitis in patients with Klebsiella septicemia, especially in diabetics with a hepatobiliary abscess. Aggressive therapy, including early vitrectomy with antibiotic injection, may improve the final outcome in this otherwise devastating ocular condition.