Endophthalmitis

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Classification according to ICD-10
H44.1 other Endophthalmitis - Parasitic endophthalmitis onA Sympathetic uveitis
ICD-10 online (WHO version 2019)
The vitreous human eye

A endophthalmitis is an inflammatory response by an infection in the eye . One also speaks of an intravitreal infection. Endophthalmitis is a very serious disease that often results in complete loss of vision or even the entire eye. Endophthalmitis is a rare but dramatic inflammation of the eye. The infection of the entire eye structure is called panophthalmitis .

etiology

With regard to the causes ( etiology ), a distinction is made between an exogenous and an endogenous infection. In the exogenous endophthalmitis an infection of the cornea (occurs cornea ), for example after an injury or after ocular surgery as a result of a non-sterile surgical conditions. The exogenous form is considerably more common than endogenous endophthalmitis as a secondary infection from organ involvement with pathogens ( bacteria , fungi , viruses or parasites ) that spread in the body (sepsis).

Usually it is a bacterial infection that occurs posttraumatically, postoperatively or metastatically (as a hematogenous infection) in immunocompromised patients ( diabetics , AIDS ) (endogenously metastatic).

Pathogen

Possible pathogens of endophthalmitis can be:

bacteria

Staphylococci , streptococci , enterococci , Enterobacteriaceae (including Klebsiella pneumoniae ), Pseudomonas aeruginosa , Bacillus spp. Proteus spp. Mycobacteria spp. Treponema pallidum

Mushrooms (fungi)

Candida spp. , Blastomyces dermatitides , Coccidoides immitis , Aspergillus spp., Mucor spp., Fusarium spp., Penicillium spp.

Viruses

Human cytomegalovirus (CMV), herpes simplex virus , varicella zoster virus , measles virus , rubella virus

Parasites

Taenia solium , Toxocara canis , Toxoplasma gondii

Symptoms

The symptoms of endophthalmitis are deep dull eye pain, an acute red eye, swelling of the conjunctiva, and decreased visual acuity.

Incidence (frequency)

In 1990 about 1200 postoperative endophthalmitis cases, that is, cases in which endophthalmitis occurred after an operation, were registered in the USA. These mostly occurred after intraocular interventions, especially after cataract extractions ( cataract operations). The incidence in the US and Germany is around 0.08%.

However, the disease occasionally occurs after minor interventions such as radial keratotomy , posterior capsulotomy , anterior chamber paracentesis, and lens reduction . The incidence after trabeculectomy and corneal transplant is approximately four to nine times as high.

In principle, endophthalmitis can occur in all operations on the eye that break through the cornea / sclera barrier.

Diagnosis

The pathogen detection from aqueous humor or the vitreous body is particularly important due to the large number of pathogens in question.

therapy

Endophthalmitis must be treated with antibiotics . The antibiotic can be given as eye drops, intravenously or as injections into ( intravitreal ) or around the eye. The following antibiotics can be used for bacterial pathogens: ampicillin , oxacillin , cefazolin together with ceftazidime , penicillin G 600 E, vancomycin and clindamycin . This local therapy must be supplemented by high-dose systemic therapy . In severe cases of endophthalmitis, surgery on the vitreous body ( vitrectomy ) may be necessary.

forecast

The prognosis depends heavily on the virulence of the germ and the duration of the infection. Often there is an extensive loss of function of the eye as a result of damage to the retina. In extreme cases, the eye must be removed ( enucleation ).

swell

  1. ↑ a b University Hospital Cologne, Intraocular Infections: Endophthalmitis ( Memento from June 10, 2007 in the Internet Archive ) (PDF; 78 kB)
  2. ↑ Thomas Kreutzer: About therapy and prognosis of endophthalmitis presented on the basis of the patient population of the eye clinic of the Ludwig Maximilians University of Munich from 1990-2001. Dissertation LMU Munich: Medical Faculty, 2005.
  3. ↑ JJ Rowsey include: Clinical diagnosis of endophthalmitis. In: Int. Ophthalmol. Clin. 27/1987, pp. 82-88.
  4. ^ H. Hatano et al .: Endophthalmitis in Japan - a nationwide study with reference to type and etiology. In: Nippon Ganka Gakkai Zasshi. 95/1991, pp. 369-376.
  5. ↑ HM Kattan et al.: Nosocomial endophthalmitis survey. Current incidence of infection after intraocular surgery. In: Ophthalmology. 98/1991, pp. 227-238.
  6. ^ DS Hughes, RJ Hill: Infectious endophthalmitis after cataract surgery. In: Br. J. Ophthalmol. 78/1994, pp. 227-232.
  7. ↑ TM Aaberg et al.: Nosocomial acuteonset postoperative endophthalmitis survey. A 10-year review of incidence and outcomes. In: Ophthalmology. 105/1998, pp. 1004-1010.
  8. ^ S. Schmitz et al.: Endophthalmitis in cataract surgery: results of a German survey. In: Ophthalmology. 106/1999, pp. 1869-1877.
  9. ↑ H. Gelender et al .: Bacterial endophthalmitis resulting from radial keratotomy. In: Am. J. Ophthalmol. 93/1982, pp. 323-326.
  10. ↑ WT Driebe, Jr., S. Mandelbaum, RK Forster, LK Schwartz, WW Culbertson: Pseudophakic endophthalmitis. Diagnosis and management. In: Ophthalmology. 1986, 93, pp. 442-448.
  11. ^ BS Prokop: Read we forget - or, every procedure carries risk. In: Ophthalmic Surg. 15/1984, p. 221.
  12. ↑ BC Joondeph, HC Joondeph: Purulent anterior segment endophthalmitis Following paracentesis. In: Ophthalmic Surg. 17/1986, pp. 91-93.
  13. ↑ LJ Katz et al: Complications of surgery in glaucoma. Early and late bacterial endophthalmitis following glaucoma filtering surgery. In: Ophthalmology. 92/1985, pp. 959-963.
  14. ^ LP Aiello et al.: National outcomes of penetrating keratoplasty. Risks of endophthalmitis and retinal detachment. In: Arch. Ophthalmol. 111/1993, pp. 509-513.
  15. ↑ M. Engelbert: Imipenem in intravenous antibiotic prophylaxis and therapy of experimental endophthalmitis caused by Staphylococcus aureus. Dissertation. LMU Munich, 1995.

literature

  • Th. T. Luther, Karl Ulrich Bartz-Schmidt: Endophthalmitis. In: Ophthalmologist. 96/1999, pp. 758-771.
  • Marianne Abele-Horn: Antimicrobial Therapy. Decision support for the treatment and prophylaxis of infectious diseases. With the collaboration of Werner Heinz, Hartwig Klinker, Johann Schurz and August Stich, 2nd, revised and expanded edition. Peter Wiehl, Marburg 2009, ISBN 978-3-927219-14-4 , p. 117 f. ( Endophthalmitis ).