Effects of the COVID-19 pandemic on clinical manifestations and therapeutic outcomes in acute endophthalmitis

Abstract

Endophthalmitis incidence and clinical characteristics was reported to change during Covid-19 pandemic, due to multiple influencing factors, such as prolonged lockdown periods, persistent immune suppression following Sars-Cov-2 infection, and mask wearing. We conducted a retrospective eight-year study, during January 2016 and December 2023, that aims to investigates the differences in terms of etiology, clinical characteristics and outcomes in cases with acute endophthalmitis, admitted before (2016-2019) and during Covid-19 pandemic (2020-2023). The two study subgroups were homogenous in term of age, gender distribution, associated comorbidities, and addressability. During Covid-19 pandemic there were significant delays in presentation (p=0.02), more cases of endogenous endophthalmitis (p=0.025), and patients presented a more intense systemic inflammatory reaction (p<0.01). Moreover, undiagnosed cases of diabetes were more frequent in pandemic group, and were associated with endogenous endophthalmitis (59.3% vs 16.6%, p<0.001). The were differences in etiology between the two subgroups, the first cases of hypervirulent Klebsiella pneumoniae endogenous endophthalmitis reported in our center. The outcomes were comparable in terms of hospital stay and rate of evisceration. However, the visual function was worse in the pandemic group, which may be correlated with the specific differences in etiology and delayed presentation. Early diagnosis and prompt initiation of large spectrum antibiotherapy are essential to preserve vision.

Keywords

• endophthalmitis
• covid-19
• outcomes
• hypervirulent
• klebsiella pneumoniae
• intravitreal antibiotherapy