Capucine Odouard1, Dai Ni Ong3,4, Parth R Shah2, Thomas Gin4,5, Penelope J Allen3,4, John Downie1 ,2, Lyndell L Lim3,4, Peter McCluskey1,6

Purpose: Endogenous Klebsiella pneumoniae endophthalmitis (EKPE) is a well-known entity in South-East Asia and, more recently, in Australia. We present 4 cases of EKPE demonstrating the range of differing clinical features and outcomes, and highlight the increasing incidence of EKPE in Australia.

Methods: EKPE cases from 2005 to 2015 were identified through established endophthalmitis databases as well as microbiological searches for positive Klebsiella pneumoniae intraocular samples.

Results: Rising trends of EKPE were noted in major centres in Australia. Six eyes of 4 patients with EKPE from January 2011 to December 2015 are reported. The mean age was 49 years (range 43-58years). Two patients had bilateral involvement. There were systemic symptoms up to 10 days prior to ocular symptoms and the source of sepsis in all cases was a hepatic abscess. Two patients had diabetes mellitus. Three eyes had initial visual acuities of less than hand movements. Five eyes had hypopyon panuveitis on presentation and all eyes underwent vitrectomy. The patient with the most delayed presentation underwent enucleation of the eye following globe perforation. Final best corrected visual acuity (BCVA) in one patient with bilateral EKPE was LP only. The other three eyes had BCVA in at least 1 eye of 6/24 or better.

Conclusion: EKPE is an emerging condition in Australia. Although rare, EKPE is a sight-threatening and potentially life-threatening emergency that can initially present to ophthalmologists. A high degree of suspicion is needed in septic patients with reduced vision or ocular pain to allow early diagnosis and treatment.