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Operative Therapie und Keimnachweis bei endogener Endophthalmitis

Datenauswertung aus 5 Augenkliniken

Surgical therapy and pathogen detection in endogenous endophthalmitis

Analysis of data from five German eye hospitals

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Zusammenfassung

Hintergrund

Die endogene Endophthalmitis entsteht durch die hämatogene Streuung einer bakteriellen oder fungalen Infektion bei schwer vorerkrankten PatientInnen. Eine systemische und intraokulare spezifische Therapie ist erforderlich. Grundlage hierfür ist der Keimnachweis aus Blutkultur oder Glaskörperprobe, die funktionellen Ergebnisse sind limitiert.

Ziel

Mit dieser Arbeit wollen die Autoren praxisnahe Hinweise zur operativen Therapie und zum Keimnachweis von PatientInnen mit endogener Endophthalmitis geben.

Methoden

Es handelt sich um eine retrospektive Analyse anonymer Daten von 68 Patientinnen aus 5 deutschen Augenkliniken aus den Jahren 2018–2023.

Ergebnisse

Das mittlere Alter der Betroffenen betrug 71,4 Jahre (minimal 31, maximal 96 Jahre). Die operative Therapie umfasste Pars-Plana-Vitrektomien (ppV) und intravitreale Injektionen (IVOM). Bei 44 von 68 PatientInnen (65 %) erfolgten 1–3 Operationen, bei 14/68 (21 %) der PatientInnen waren 4–6 Operationen erforderlich, und bei 4/68 PatientInnen (6 %) 10 oder mehr Operationen. Der Keimnachweis war in 34 % der Glaskörperproben möglich, aus einem Vorderkammerpunktat in 11 %. Der mittlere initiale Visus war logMAR 1,5. Nach Therapie und einem mittleren Follow-up von 2,5 Monaten betrug er im Mittel logMAR 1,3. Präanalytische Verfahren zur Probenentnahme wie das Freiburger Endophthalmitis-Set zur Optimierung des Keimnachweises werden dargestellt.

Schlussfolgerung

Schwere entzündliche intraokulare Reaktionen bei endogener Endophthalmitis machen eine Kombination aus ppV und wiederholter IVOM notwendig. Die ppV dient neben der Bereitstellung einer Glaskörperprobe auch der Entfernung entzündlicher Fibrinmembranen. Ein frühzeitige ppV mit spezifischer antibiotischer oder antifungaler Therapie ist neben Fokussuche und systemischer Therapie anzustreben.

Abstract

Background

Endogenous endophthalmitis results from hematogenous spread of bacterial or fungal infection in severely diseased patients. Specific systemic and intraocular therapy is required. The basis for this treatment is causal pathogen detection in blood culture or vitreous sample. However, functional results are limited.

Objective

The current article provides practical hints for surgical therapy and pathogen detection in patients with endogenous endophthalmitis.

Methods

A retrospective analysis of anonymous data of 68 male and female patients from 2018–2023 from five ophthalmology clinics in Germany was performed.

Results

Mean age of affected patients was 71.4 years (31–96 years). Surgical therapy included pars plana vitrectomy (ppV) and intravitreal injection (IVOM). In 44 of 68 patients (65%), 1–3 surgeries were performed, 4–6 surgeries were required in 14/68 (21%) of patients, and 10 or more surgeries were required in 4/68 patients (6%). Pathogen detection was possible in 34% of vitreous specimens and in 11% of anterior chamber samples. Mean initial visual acuity was logMAR 1.5. After treatment and a mean follow-up of 2.5 months, mean visual acuity was logMAR 1.3. Preanalytical methods for specimen collection like the Freiburg endophthalmitis set to optimize pathogen detection are presented.

Conclusion

Severe inflammatory intraocular reactions in endogenous endophthalmitis necessitate a combination of ppV and repeated IVOM. In addition to providing a vitreous sample, ppV also serves to remove inflammatory fibrin membranes. Early pars plana vitrectomy with specific antibiotic or antifungal therapy should be sought in addition to the focus search and systemic therapy.

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Authors and Affiliations

  1. Augenklinik Klinikum Ernst-von-Bergmann Potsdam, Potsdam, Deutschland, Charlottenstr 72, 14467

    Ameli Gabel-Pfisterer, Stephanie Kischio & Mandana Keen

  2. Augenklinik, Medizinische Hochschule Brandenburg, Brandenburg, Deutschland

    Ameli Gabel-Pfisterer

  3. Klinik für Augenheilkunde, Universitätsklinikum Freiburg, Freiburg im Breisgau, Deutschland

    Thomas Neß & Daniel Böhringer

  4. Universitätsaugenklinik Tübingen, Tübingen, Deutschland

    Karl-Ulrich Bartz-Schmidt, Albrecht Bartz-Schmidt & Florian Gekeler

  5. Augenklinik am Katharinenhospital, Klinikum Stuttgart, Stuttgart, Deutschland

    Florian Gekeler

  6. Institut für Medizinische Mikrobiologie und Virologie, Universitätsmedizin Göttingen, Göttingen, Deutschland

    Michael Weig

  7. Augenklinik der Universitätsmedizin Göttingen, Göttingen, Deutschland, 37075, Robert-Koch-Strasse 40

    Marcus Storch & Nicolas Feltgen

  8. Augenklinik, Universitätsspital, Basel, Schweiz, Mittlere Strasse 91, 4031

    Nicolas Feltgen

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  1. Ameli Gabel-Pfisterer
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Corresponding author

Correspondence to Ameli Gabel-Pfisterer.

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Interessenkonflikt

A. Gabel-Pfisterer, S. Kischio, M. Keen, K.U. Bartz-Schmidt, A. Bartz-Schmidt, F. Gekeler, T. Neß, D. Böhringer, M. Weig, M. Storch und N. Feltgen geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Gabel-Pfisterer, A., Kischio, S., Keen, M. et al. Operative Therapie und Keimnachweis bei endogener Endophthalmitis. Ophthalmologie 121, 282–290 (2024). https://doi.org/10.1007/s00347-024-02018-4

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