Echographic findings in infectious endophthalmitis

M. P. Dacey, M. Valencia, M. B. Lee, P. U. Dugel, R. R. Ober, R. L. Green and P. F. Lopez
Doheny Eye Institute, University of Southern California School of Medicine, Los Angeles.

OBJECTIVE: To correlate the initial echographic findings in eyes with infectious endophthalmitis with the visual prognosis and causative microorganism. DESIGN: A retrospective review of the clinical and standardized ocular echographic findings in eyes with infectious endophthalmitis was performed. SETTING: University-based ophthalmology department. STUDY PARTICIPANTS: One hundred thirty-seven eyes (136 patients) with infectious endophthalmitis that were evaluated by the ocular echography service of the Doheny Eye Institute, Los Angeles, Calif, between January 1, 1981, and December 31, 1992. RESULTS: Four findings on initial echography were associated with poor initial vision: dense vitreous opacities, retinal detachment, macular detachment, and choroidal detachment. Five findings on initial echography correlated with poor final vision: dense vitreous opacities, vitreous membranes, the presence of retinal detachment, the extent of retinal detachment, and the presence of choroidal detachment. Change (decrease) in vision during the follow-up period was associated with the presence of combined vitreous and subhyaloid opacities, retinal detachment, and choroidal detachment. All eyes with initially clear vitreous on ocular echography had either early streptococcal or culture-negative endophthalmitis. Advanced streptococcal endophthalmitis correlated with the most severe vitreous inflammation, vitreous membranes, and the most extensive posterior vitreous detachment, whereas gram-negative endophthalmitis correlated with choroidal detachment on initial echography. Stepwise logistic regression analysis revealed that the presence of choroidal detachment, not gram-negative microorganisms, was the principal predictor of poor visual outcome in these eyes. CONCLUSION: Ocular echography is a useful method in the clinical evaluation and treatment of infectious endophthalmitis, especially in eyes with opaque media.