Analysis of 13 Misdiagnosed Cases of Endogenous Endophthalmitis and the Related Literature Review

ZHANG Yuan-xia; TANG Jian-cheng

doi:10.3969/j.issn.1002-3429.2016.05.020

Abstract：Objective To analyze causes of misdiagnosis of endogenous endophthalmitis so as to study the measures taken as a precaution against misdiagnosis .Methods Clinical data of 13 cases of endogenous endophthalmitis , who had been misdiagnosed and hospitalized in the General Hospital of PLA between January 2009 and January 2015 were analyzed retro-spectively, and the related literatures were reviewed .Results In these 13 cases, 12 cases first visited local hospitals for like red eye and (or) sore eye, and decreased visual acuity, 4 cases were misdiagnosed as uveitis, 2 cases as acute retinal necro-sis syndrome, 2 cases as acute angle-closure glaucoma, 5 cases were misdiagnosed as iridocyclitis , keratitis, conjunctivitis, orbital cellulitis , or exudative retinal detachment respectively .Another case with red eye and increased eye secretion was mis-diagnosed as conjunctivitis after the first consultation of ophthalmology .The misdiagnosis time was 7-83 d, with an average of 26.2 d.Diagnosis can be confirmed by integrating medical history , symptoms, signs and the etiological examination results . In all of the 8 cases undergoing vitrectomy based on medication , postoperative visual acuity remained unchanged in 3 cases and increased in 5 cases.2 cases received intravitreal injection of Vancomycin hydrochloride combined with intravenous infusions of the third generation cephalosporin and inflammation was controlled and visual acuity increased .2 eyes underwent eye con-tents enucleation with visual loss .1 case gave up eye treatment , and the prognosis was unknown .Conclusion The early clinical manifestations of endogenous endophthalmitis lack specificity , and there is a high misdiagnosis rate in the first visit . Enhanced awareness of this disease , inquiry of detailed medical history ,careful examination and repetitive eye check are es-sential in reducing and avoiding misdiagnosis in endogenous endophthalmitis .