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Shields, Ryan A., MD; Smith, Stephen J., MD; Pan, Carolyn K., MD; Do, Diana V., MD

doi: 10.1097/IAE.0000000000001994
Original Study: PDF Only

Purpose: To report the clinical features, treatment modalities, and visual outcomes in 12 eyes with endogenous Klebsiella pneumoniae endophthalmitis (EKPE).

Methods: The medical records of all patients diagnosed with EKPE at Stanford Hospital (Palo Alto, CA) and Santa Clara Valley County Hospital (Santa Clara, CA) from January 2000 to March 2017 were retrospectively reviewed.

Results: A total of 10 patients (12 eyes) were diagnosed with EKPE. The median age at presentation was 56, 80% were male, and 30% were non-Asian. Presenting visual acuities ranged from 20/20 to no light perception. Of the 12 eyes 10 received a tap and injection (range, 1–33 injections per eye), 2 eyes underwent primary enucleation or evisceration, and 1 patient underwent pars plana vitrectomy after tap and injection. Final visual acuities ranged from no light perception (six eyes) to 20/300 or better (five eyes). Five patients eventually underwent evisceration or enucleation. All cases were associated with positive blood and/or vitreous cultures and had concurrent systemic infection.

Conclusion: Endogenous Klebsiella pneumoniae endophthalmitis is a rare, but devastating, ocular infection. Most cases in this series resulted in light perception vision or worse, and almost half required enucleation or evisceration. In light of the virulence of EKPE, early diagnosis and treatment should be initiated in all suspected cases.

We report the largest American case series of endogenous Klebsiella pneumoniae endophthalmitis. Endogenous Klebsiella pneumoniae endophthalmitis occurs most frequently in Asian patients, but can be seen in other ethnicities. Endogenous Klebsiella pneumoniae endophthalmitis frequently presents as a fulminant ocular infection, and vision outcomes of no light perception are common despite aggressive treatment. A significant portion of cases result in enucleation or evisceration.

Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California.

Reprint requests: Diana V. Do, MD, 2452 Watson Court, Palo Alto, CA 94303; e-mail:

None of the authors has any financial/conflicting interests to disclose.

© 2019 by Ophthalmic Communications Society, Inc.