PREDICTORS OF POOR VISUAL OUTCOMES IN PATIENTS WITH ENDOPHTHALMITIS AT THE PROVINCIAL REFERRAL HOSPITAL IN BANDA ACEH A RETROSPECTIVE STUDY
Article Sidebar
Main Article Content
http://orcid.org/0000-0003-2352-7131
Enny Nilawati
http://orcid.org/0009-0000-3291-5166
Cut Putri Samira
http://orcid.org/0009-0008-9241-0977
Putri Nabillah Mulya
http://orcid.org/0000-0001-5468-5568
Dian Islami
http://orcid.org/0009-0000-3300-9229
Abstract
Introduction: Endophthalmitis is a severe intraocular infection that can lead to irreversible visual loss. Visual outcomes are influenced by several clinical and management factors, but data from Indonesia remain limited. This study aimed to describe the clinical and demographic characteristics of patients with infectious endophthalmitis and identify predictors of poor visual outcomes at a tertiary hospital in Aceh, Indonesia.
Methods: This retrospective study included 94 patients diagnosed with infectious endophthalmitis at Dr. Zainoel Abidin General Hospital, Banda Aceh, between December 2021 and November 2024. Data on demographics, clinical presentation, microbiology, management, and visual acuity were extracted from medical records. Visual outcomes were categorized as <1/60 versus ?1/60. Multivariate logistic regression was performed to determine predictors of poor or unassessed outcomes.
Result: The mean patient age was 52.8 years, with 63.8% male. Exogenous endophthalmitis was the predominant type (93.6%), most commonly occurring after cataract surgery (47.9%). At presentation, 88.3% of patients had VA <1/60. Vitreous cultures were positive in 28.8% of cases, with Pseudomonas spp. and Staphylococcus spp. being the most frequent isolates. The majority of patients (58.5%) underwent pars plana vitrectomy (PPV), while 12.8% required evisceration. At follow-up, 50% had VA <1/60, 11.7% achieved VA >6/45, and 13.8% were lost to follow-up. Multivariate analysis identified poor initial VA (<1/60) (Odd Ratio (OR) 6.41, 95% CI: 1.03–39.76, p=0.046) and short follow-up (<1 month) (OR 5.13, 95% CI: 1.33–19.78, p=0.017) as independent predictors of poor or unassessed outcomes. Non-PPV management showed a non-significant trend toward worse outcomes (OR 3.29, p=0.057).
Conclusion: Poor presenting visual acuity and inadequate follow-up were strong predictors of poor outcomes in endophthalmitis. These findings highlight the importance of early recognition, patient education, and system-level support for follow-up, particularly in resource-limited settings.
Keywords
Endophthalmitis, Visual Acuity, Pars Plana Vitrectomy, Predictive Factors, Treatment Outcome, Indonesia
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
References
2. Torres-Costa S, Ramos D, Brandão E, et al. Incidence of endophthalmitis after intravitreal injection with and without topical antibiotic prophylaxis. European Journal of Ophthalmology. 2021;31(2):600-606.
3. Bohrani Sefidan B, Tabatabaei SA, Soleimani M, et al. Epidemiological characteristics and prognostic factors of post-traumatic endophthalmitis. Journal of International Medical Research. 2022;50(2):03000605211070754.
4. Hapca M-C, Vesa ?C, Nicoar? S-D. Visual Outcomes and Prognostic Factors of Traumatic Endophthalmitis Treated by Pars Plana Vitrectomy: 11 Years Retrospective Analysis. Journal of Clinical Medicine. 2023;12(2):502.
5. Lee JJ, Jo YJ, Lee JS. Clinical characteristics and risk factors for visual prognosis according to the types of infectious endophthalmitis. PLOS ONE. 2022;17(12):e0278625.
6. Liu P, Yang J-W, Chaou C-H, Seak C-J, Yeh H-F. Clinical presentation and prognostic factors in emergency department endophthalmitis: a 11-year retrospective study. Signa Vitae. 2025;21(2).
7. Ma J, Yu Y, Zhong Y, Mao X, Fang X. Outcomes and Prognostic Factors of Posttraumatic Endophthalmitis: A Three-Year Retrospective Study. Journal of Ophthalmology. 2021;2021(1):5526998.
8. Tabatabaei SA, Masoumi A, Mirzaei A, et al. Infectious Endophthalmitis: An Overview of Clinical Features, Microbiology Profile, and Antibiotic Sensitivity Pattern. J Curr Ophthalmol. 2024;36(3):284-290.
9. VanderBeek BL, Chen Y, Tomaiuolo M, et al. Endophthalmitis Rates and Types of Treatments After Intraocular Procedures. JAMA Ophthalmol. 2024;142(9):827-834.
10. Teh BL, Ong AY, Mehta A, et al. Long term analysis of microbiological isolates and antibiotic susceptibilities in acute-onset postoperative endophthalmitis: a UK multicentre study. Eye (Lond). 2025;39(8):1470-1475.
11. Gao Z, Zhang Y, Gao X, et al. Clinical analysis and predictive factors associated with improved visual acuity of infectious endophthalmitis. BMC Ophthalmology. 2020;20(1):256.
12. Rahmani S, Eliott D. Postoperative Endophthalmitis: A Review of Risk Factors, Prophylaxis, Incidence, Microbiology, Treatment, and Outcomes. Semin Ophthalmol. 2018;33(1):95-101.
13. Atima MO, Orugun AJ, Idakwo U, et al. Postoperative endophthalmitis following cataract surgery: Incidence and visual outcomes at ECWA Eye Hospital, Kano, Nigeria. JFO Open Ophthalmology. 2025;11:100168.
14. Pathengay A, Khera M, Das T, et al. Acute Postoperative Endophthalmitis Following Cataract Surgery: A Review. Asia Pac J Ophthalmol (Phila). 2012;1(1):35-42.