Table 1.
Clinical characteristics of 24 COVID-19 patients with endogenous endophthalmitis
| # | Age/Gender | Comorbidities | Clinical Classification of COVID-19 /Hospitalization/Oxygen use/ICU admission Ventilator | Steroid/Broad-spectrum antibiotics/Anticoagulants/Tocilizumab/Antiviral | Time to eye symptom and COVID-19 symptoms in days | Laterality |
|---|---|---|---|---|---|---|
| 1 | 53/F | DM, CKD | Severe COVID-19, ARDS, Sepsis, Hospitalisation, O2, ICU | Broad-spectrum antibiotics | 33 | BE |
| 2 | 58/M | DM | Moderate COVID-19, Hospitalization, ICU | IVMP, Oral steroid, Broad-spectrum antibiotic, Enoxaparin, Tocilizumab, Remdesivir | 37 | RE |
| 3 | 72/M | DM | Moderate COVID-19, Hospitalization, ICU | IVMP, Broad-spectrum antibiotic, Flavipiravir | 32 | RE |
| 4 | 55/M | DM, CKD, EPN (Stenting and PCN) | Severe COVID-19, Hospitalisation, ICU, O2 | IVMP, Broad-spectrum antibiotics, Remdesivir, Favipiravir | 11 | RE |
| 5 | 49/M | HTN, DM*, EPN (Stenting and PCN) | Severe COVID-19, ARDS, Sepsis, Hospitalisation, ICU, Dialysis, O2 | IVMP, Broad-spectrum antibiotic, Remdesivir, Favipiravir, Enoxaparin | 10 | BE |
| 6 | 49/F | DM | Mild COVID-19, Hospitalisation | Oral steroid, Broad-spectrum antibiotic, Favipiravir | 17 | LE |
| 7 | 53/F | DM, Pots spine (TB reactivation)∫ | Severe COVID-19, ARDS, Sepsis, Septic shock, Hospitalisation, ICU, O2, Ventilator | IVMP, Enoxaparin, Broad-spectrum antibiotics, Remdesivir | 17 | BE |
| 8 | 56/F | DM, CKD, HTN, EPN (JJ stenting) | Severe COVID-19, Hospitalisation, ICU, O2, Sepsis | Oral steroid, Broad-spectrum antibiotics, Favipiravir | 37 | LE |
| 9 | 65/M | DM, CKD, EPN, JJ stenting with PCN | Severe COVID-19, Hospitalisation, ICU, O2, Sepsis | IVMP, Enoxaparin, Broad-spectrum antibiotics, Tocilizumab, Remdesivir | 17 | BE |
| 10 | 54/F | DM, HTN | Mild COVID-19, Hospitalisation | Oral steroid, Broad-spectrum antibiotics, Favipiravir | 12 | RE |
| 11 | 40/M | DM | Severe COVID-19, Hospitalisation, ICU, O2 | IVMP, Oral steroid, Enoxaparin, Broad-spectrum antibiotics, tocilizumab, Remdesivir | 10 | BE |
| 12 | 35/M | Sinusitis, Mastoiditis, Meningitis | Severe COVID-19, ARDS, Sepsis, Septic shock, Hospitalisation, ICU, O2, Sepsis | IVMP, Enoxaparin, Broad-spectrum antibiotics, Remdesivir | 16 | BE |
| 13 | 65/M | DM | Severe COVID-19, ARDS, Sepsis, Septic shock, Hospitalisation, ICU, O2, Ventilator, Sepsis | IVMP, Enoxaparin, Broad-spectrum antibiotics, Tocilizumab, Remdesivir | 6 | RE |
| 14 | 59/M | DM, HTN | Severe COVID-19, ARDS, Sepsis, Hospitalisation, ICU, O2 | IVMP, Oral steroid, Enoxaparin, Broad-spectrum antibiotics, Tocilizumab, Remdesivir | 10 | RE |
| 15 | 63/F | DM, HTN, Hypothyroidism | Severe COVID-19, ARDS, Sepsis, Septic shock, Hospitalisation, ICU, O2, Sepsis | IVMP, Oral steroid, Enoxaparin, Broad-spectrum antibiotics, Tocilizumab, Remdesivir | 40 | BE |
| 16 | 55/M | DM* | Moderate COVID-19, Hospitalisation, O2 | IVMP, Oral steroid, Broad spectrum ant78ibiotics, Tocilizumab, Remdesivir | 40 | RE |
| 17 | 67/M | DM, HTN, EPN | Moderate COVID-19, Hospitalisation, O2, Sepsis | Oral steroid, Ecosprine, Broad spectrum antibiotics, Remdesivir, Favipiravir | 60 | LE |
| 18 | 55/M | DM | Moderate COVID-19, Hospitalisation, O2 | IVMP, Oral steroid, Enoxaparin, Broad-spectrum antibiotics, Tocilizumab, Remdesivir | 54 | RE |
| 19 | 53/M | HTN, CKD | Severe COVID-19, Hospitalisation, ICU, O2 | IVMP, Enoxaparin, Ecosprin, Broad-spectrum antibiotics, Tocilizumab, Remdesivir | 47 | LE |
| 20 | 5/M | Nil | Asymptomatic, Hospitalisation | Oral steroid, broad-spectrum antibiotics, | 70 | BE |
| 21 | 49/M | DM*, CKD, DKA, Anaemia | Severe COVID-19, Hospitalisation, ICU, O2, Sepsis | IVMP, Oral steroid, Enoxaparin, Broad-spectrum antibiotics, Tocilizumab, Remdesivir, Favipiravir | 30 | BE |
| 22 | 57/M | DM | Moderate COID, Hospitalisation, O2 | Oral steroid (DEXA), Enoxaparin, Broad-spectrum antibiotics, Remdesivir, | 48 | LE |
| 23 | 71/F | DM* | Moderate COVID-19, Hospitalisation, O2 | IVMP, Enoxaparin, Broad-spectrum antibiotics, Tocilizumab, Remdesivir, | 10 | BE |
| 24 | 50/M | DM*, GBS | Severe COVID-19, Hospitalisation, ICU, O2 | Oral (Dexa), Enoxaparin, Broad spectrum antibiotics, Tocilizumab, Remdesivir, Favipiravir | 72 | RE |
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| # | Management of endophthalmitis | Result of microbiology/histopathology investigations on vitreous fluid/eviscerated content (microscopy/culture/PCR/histopathology) | Systemic investigations (culture/tissue biopsy) | FU (days) | Outcome | |
|
| ||||||
| 1 | Oral ciprofloxacin, Single intraocular broad-spectrum antibiotic injection in the emergency room. | Not done | BC: -Ve UC:-Ve | 2 | Deceased | |
| 2 | Intravenous caspofungin Vitreous biopsy, Vitrectomy, Vitreous lavage, Silicone oil injection, 12 times intraocular amphotericin-B | Candida tropicalis | BC:-Ve UC:-Ve | 134 | Systemically doing well, resolved eye infection, 20/800 vision, profound visual impairment | |
| 3 | Intravenous Caspofungin | Not done | BC:-Ve UC:-Ve | 30 | Systemically doing well, resolved eye infection, 20/250 vision, severe visual impairment | |
| 4 | Oral ciprofloxacin Vitreous biopsy, Vitrectomy, Vitreous lavage, Silicone oil injection, 4 times intraocular antibiotics (vancomycin and ceftazidime) | Gram-positive cocci | Streptococcus pneumonia in BC and UC | 164 | Systemically doing well, resolved eye infection, HM vision, near-total blindness | |
| 5 | Intravenous caspofungin Vitreous biopsy, Vitrectomy, Vitreous lavage, Silicone oil injection, 9 times intraocular amphotericin-B | Candida cifferi | Candida sp in BC and UC | 134 | Systemically doing well, resolved eye infection light perception vision, both eyes, extensive scarring of the retina near-total blindness | |
| 6 | Oral ciprofloxacinVitreous biopsy, Vitrectomy, 2 times intraocular antibiotic injections | -Ve | BC: -Ve UC:-Ve | 120 | Systemically doing well, 20/40 vision mild visual impairment | |
| 7 | Systemic antitubercular medication, Intravenous caspofungin | -Ve | Candida sp. In BC and UC | 30 | Deceased | |
| 8 | Oral ciprofloxacin Vitreous biopsy, Vitrectomy, Vitreous lavage, Silicone oil injection, 4 times intraocular vancomycin and ceftazidime injection | Gram-positive cocci | Streptococcus pneumonia in BC and UC | 90 | Systemically doing well, resolved eye infection HM vision, near-total blindness | |
| 9 | Oral ketoconazole Vitreous biopsy, Vitrectomy, 2 times intraocular amphotericin-B injection | Aspergillus flavus | BC:-Ve UC:-Ve Aspergillus sp in kidney biopsy | 90 | Systemically doing well, resolved eye infection light perception vision, both eyes Near-total blindness | |
| 10 | Oral ketoconazole | Not done | Not done | 7 | Systemically doing well, noncompliance lost vision, no light perception Phthisis bulbi, Total blindness | |
| 11 | Oral ciprofloxacin Vitreous biopsy, Vitrectomy, and single intraocular antibiotic (vancomycin and ceftazidime) | -Ve | Escherichia coli in BC and UC | 90 | Systemically doing well resolved eye infection, 20/25 vision mild visual impairment | |
| 12 | Oral and intravenous voriconazole | Not done | BC:-ve UC:-ve Aspergillus sp. in paranasal sinus biopsy culture | 7 | Deceased | |
| 13 | Intravenous amphotericin-B, Oral and intravenous posaconazole, Evisceration | Mucormycete in histopathology | BC:-ve UC:-ve Mucor sp. in paranasal sinus biopsy culture | 60 | Deceased | |
| 14 | Intravenous voriconazole, Vitreous biopsy, Vitrectomy, Silicone oil injection, 2 times intraocular amphotericin and voriconazole | Fusarium equiseti | BC:-Ve UC:-Ve | 90 | Systemically doing well, resolved eye infection HM vision, profound visual impairment | |
| 15 | Intravenous caspofungin | Not done | Candida sp. in BC and UC | 7 | Deceased | |
| 16 | Intravenous voriconazole Vitreous biopsy, Vitrectomy, 3 times intraocular amphotericin and voriconazole injection | -Ve | BC: Candida sp. UC:-Ve | 60 | Systemically doing well lost eye, phthisis bulbi, no light perception, Total blindness | |
| 17 | Oral fluconazole, Vitreous biopsy, Vitrectomy, 6 times intraocular amphotericin-B injection | Candida sp. | BC-Ve UC: Candida sp. | 80 | Systemically doing well, 20/200 vision with foveal scarring, severe visual impairment | |
| 18 | Oral fluconazole Vitreous biopsy, Vitrectomy, 6 times intravitreal amphotericin injection | Candida tropicalis | Not done | 132 | Systemically doing well resolved eye infection 20/25 vision, mild visual impairment | |
| 19 | Intravenous voriconazole Vitreous biopsy, Vitrectomy, 6 times intravitreal amphotericin-B and voriconazole injection | Aspergillus fumigatus | BC:-Ve UC:-Ve | 90 | Systemically doing well, resolved eye infection hand motion vision near-total blindness | |
| 20 | Oral valaciclovir Vitreous biopsy, vitrectomy | HSV-1 DNA | BC; -Ve UC:-Ve | 127 | Systemically doing well, resolved eye infection 20/200 vision, severe visual impairment | |
| 21 | Oral fluconazole Vitreous biopsy, Vitrectomy 3 times intraocular amphotericin and voriconazole | Candida tropicalis | BC:-Ve UC:-Ve | 90 | Systemically doing well, resolved ye infection 20/800 vision, profound visual impairment | |
| 22 | Oral fluconazole, Oral acyclovir Vitreous biopsy, Vitrectomy, Vitreous lavage, 3 times intraocular amphotericin B and voriconazole, 4 times intravitreal ganciclovir | -Ve | BC:-Ve UC:-Ve | 140 | Systemically doing well, resolved eye infection, counting finger close to face vision, scarred retina, profound visual impairment | |
| 23 | Intravenous caspofungin, Vitreous biopsy, Vitrectomy, 3 times intraocular amphotericin b and voriconazole | Fungal DNA | Not done | 90 | Systemically doing well, resolved eye infection 20/40 vision in the right eye, 20/100 vision in the left eye moderate visual impairment | |
| 24 | Oral fluconazole Vitreous biopsy, vitrectomy, 5 times intraocular amphotericin | Candida tropicalis | BC:-Ve UC: Escherichia Coli | 30 | Systemically doing well resolved eye infection, 20/25 vision, mild visual impairment | |
ARDS - acute respiratory distress syndrome; BC - blood culture; CKD - chronic kidney disease; COVID-19 - coronavirus disease; dexa - dexamethasone; DM - diabetes mellitus; EPN, emphysematous pyelonephritis; FU - follow-up; GBS - Guillain-Barre syndrome; HSV-1 - herpes simplex virus-1; HTN - hypertension; ICU - intensive care unit; IVMP - intravenous methyl prednisolone; OS - ocular sample; OSC - ocular sample culture; PCN - percutaneous nephrostomy; PCR - polymerase chain reaction; TB - tuberculosis; UC - urine culture; -Ve-negative. *New-onset diabetes mellitus. ∫During COVID-19 management, she developed reactivation of tuberculosis in the spine