Pseudomonas Aeruginosa Caused Endophthalmitis Leads to Poor Visual Outcomes

For eyes with Pseudomonas aeruginosa endophthalmitis, visual outcomes remain poor, and will require evisceration, according to a retrospective analysis published in the Journal of Ophthalmology.

The researchers considered patient records (N=36) collected between 2013 and 2019 from the Zhongshan Ophthalmic Center in China and evaluated them for clinical features, treatments, and outcomes.

Patients were aged median 54 (range, 6-85) years, 72.2% were boys or men, 4 patients had orbital cellulitis, 2 had panophthalmitis, and 13 had systemic diseases of diabetes, gastric ulcer, hydronephrosis, hypertension, kidney stones, kidney transplantation, and syphilis.

P. aeruginosa endophthalmitis was associated with trauma (n=15), a corneal ulcer (n=9), an operation (n=5), was endogenous (n=3), and unknown (n=4).

After diagnosis, all patients received intravenous antibiotics except for the patient with kidney transplant who received topical treatment. A total of 10 antibiotics were found to have some resistance. The antibiotics which had more cases of resistance were azithromycin, cefepime, ceftazidime, piperacillin, and tazobactam. The antibiotics with no resistance cases were amikacin, ciprofloxacin, gentamicin, levofloxacin, and tobramycin. Concomitant corticosteroids were administered to 25, dexamethasone to 19, subconjunctival tobramycin plus dexamethasone injections to 7, and prednisolone to 6.

Ultrasound revealed all patients had turbidity of the vitreous and 15 also had retinal detachment.

Most patients (n=31) underwent surgical intervention and 16 underwent evisceration. The patients who did not receive surgery had control of the infection (n=4) or were transferred to another center due to probable intracranial infection (n=1).

The final visual acuity was light perception or no light perception (40.0%), hand movements (40.0%), and counting fingers or better (20.0%).

The major limitation of the study was the small sample size.

“The outcomes of treatment for Pseudomonas aeruginosa endophthalmitis in the current study were poor and are consistent with previous literature on this subject. Sixteen patients underwent evisceration. Only one patient had a visual acuity of 20/400, and the other patients had a visual acuity of counting fingers or below,” the study authors report.