Endogenous endophthalmitis in the developing world

The profile of the patient at highest risk of endogenous endophthalmitis would be a diabetic patient with hepatobiliary infection, especially among patients of East Asian ethnicity. In the White patient, endogenous bacterial endophthalmitis is seen more commonly in the context of gram positive bacteremia, arising from infection of the skin, joint, or endocarditis in predisposed individuals. Infection with virulent organisms usually denotes grave visual prognosis. Current recommendations for empirically treating suspected bacterial endophthalmitis involve combination therapy targeting both gram-positive and gram-negative organisms. Therapeutic combinations of antibiotics should be tailored to the clinical scenario in which endophthalmitis develops and should target the most common causative organisms. Fungal therapy is considered when clinical history and ocular features justify this approach. Owing to the low permeability of pigmented epithelium to systemically administered drugs, intravitreal antibiotics or antifungals are used in cases in which systemic treatment is ineffective or after procedures such as vitrectomy and vitreous tap. Regarding optimized therapy in such patients, further studies are required. The outcome of endogenous endophthalmitis (compared with that of exogenous endophthalmitis) is disappointing. The 3 main factors that result in a poor prognosis, include more virulent organisms, compromised host conditions, and delay in diagnosis. Even with aggressive treatment, in only about 40% of patients is useful vision preserved.