# Endogenous endophthalmitis complicating infective endocarditis: a multicentre case-matched control cohort

## TL;DR

Endogenous endophthalmitis is a rare but severe eye complication of infective endocarditis, requiring early detection to prevent vision loss.

## Contribution

A multicenter study identifies clinical and microbiological differences in patients with IE-related endogenous endophthalmitis compared to controls.

## Key findings

- EE patients had higher rates of diabetes, cirrhosis, glomerulonephritis, embolism, and Janeway lesions compared to controls.
- Streptococcal infections were more common in EE patients, while Enterococcal infections were less common.
- Most EE patients received intravitreal antibiotic injections, with partial visual improvement in 55% of cases.

## Abstract

Endogenous endophthalmitis (EE) is a rarely reported complication of infective endocarditis (IE). In an international series, we sought to determine the clinical and microbiological profile, treatment, and outcome of patients presenting with IE-related EE.

Cases recorded from 2014 to 2023 in nine centres in Europe and the United States were collected. Results were compared to a matched control group.

Sixty-six patients with EE were reported, mean age of 65.2 ± 14.9 years, 71% (n = 47) male. Blood cultures were positive in 97% (64 cases) of patients, with a predominance of streptococci (46%, n = 30).

As compared with the control group (n = 264), the EE group presented with more frequent diabetes (35% vs. 21%, P = 0.02), history of cirrhosis (9% vs. 3%, P = 0.04), glomerulonephritis (15% vs. 0.4%, P < 0.001), embolism before admission (92% vs. 55%, P < 0.001), and Janeway lesions (9% vs. 1%, P = 0.002). Streptococcal infection (46% vs. 26%, P = 0.001) was more frequent and Enterococcal infection (0% vs. 18%, P < 0.001) less frequent in the EE group.

The main ocular symptoms were a decrease in visual acuity (96%), red eye (55%), and ocular pain (55%). Treatment of EE consisted of intravitreal antibiotic injection in 55 (83%) patients and vitrectomy in 17 (26%). Improvement of visual acuity was observed in 36 (55%) patients.

EE is a serious complication of IE with severe residual vision impairment. Patients with IE should be evaluated for ocular complications, since early detection of EE is crucial to prevent delays in management and to preserve visual function.

Graphical Abstract