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2017 OMIG Abstract 16

Associations between clinical outcomes and molecular diagnoses of post-surgical endophthalmitis
Cecilia Lee, MD MS, Sundeep Kasi MD, Bryan Lee, Hannah Walsh, Aaron Y. Lee MD, MSCI,
Sunir Garg, MD, Russell Van Gelder, MD PhD on behalf of Endophthalmitis Study Group
University of Washington, Seattle, WA

Purpose: To determine the associations between clinical outcomes and molecular diagnoses of patients with post-surgical endophthalmitis

Design: Prospective, multicenter, cohort study

Participants: All consecutive patients diagnosed with post-surgical endophthalmitis (endophthalmitis within 6 weeks of an intraocular procedure or surgery) with visual acuity better than no light perception from University of Washington and Wills Eye Hospital were recruited into the study from October 1, 2014 to April 30, 2017.

Methods: All patients underwent ocular biopsy (aqueous or vitreous) and intravitreal antibiotic injections as part of routine care. The ocular samples were sent for traditional microbial culture, qPCR (actin, 16S, torque teno virus [TTV], merkel cell polyomavirus [MCV]) and whole-genome sequencing (WGS). Clinical data were obtained at enrollment, week1, month1 and month 3. In addition to descriptive statistics, Wilcoxon-rank sum/Kruskal Wallis tests were performed when appropriate.

Main Outcome Measures: 1) Visual acuity (VA) at month 1; 2) molecular diagnoses

Results: 52 patients were recruited from two sites.  Mean age was 70 (range 36-98) and 52% were male. 30 cases (58%) occurred following cataract surgery and 8 (15%) following intravitreal injections. Median time to presentation was 3 days earlier in culture positive than culture negative cases (5 vs. 8, p<2.2e-16).  24 were culture positive and 28 were culture negative. Common cultured organisms were Staphylococcus epidermidis (staph epi) (10/24), other Staphylococcus species (9/24) and Streptococcus species (4/24). Baseline visual acuity, anterior segment inflammation and vitreous haze did not differ by culture status or cultured organisms (Staph epi vs. other culture positive cases vs. culture negative cases). VA at month 1 was 1.31 (SD1.12, Snellen 20/408) for culture positive and 0.95 (SD 0.82, Snellen 20/178) for culture negative cases (p-value 0.008). Of note, visual acuity and anterior chamber (AC) inflammation in culture positive cases (except for Staph epi) trended worse than either Staph epi or culture negative cases during week 1 and month 1 although not reaching statistical significance. At enrollment, visual acuity in samples with TTV was significantly worse than those without TTV (p-value 0.007) while AC inflammation was also higher but not significant (p=0.076). No significant clinical correlation with MCV status was found. WGS was performed in 48 samples and confirmed the culture pathogen as the leading organism in 20/22 samples. Staph epi was identified as the leading organism in 10/26 culture negative samples by WGS.

Conclusion: The clinical outcomes of post-surgical endophthalmitis are associated with the causative pathogen. Advanced molecular techniques that can identify additional pathogens or concurrent viruses may be helpful in future prognosis and treatment.

2017 Agenda and Abstracts | < Previous Next >