RARE DISEASE
Endophthalmitis
Endophthalmitis
Endophthalmitis
Drug discovery
3
drugs
With orphan designations
Overview
Endophthalmitis is a vision-threatening infection involving intraocular fluids (vitreous/aqueous), typically caused by bacteria (e.g., Staphylococcus spp.) or fungi. It manifests as acute-onset pain, vision loss, hypopyon, and vitreous haze, requiring immediate intervention to prevent irreversible damage. Most cases occur postoperatively (e.g., cataract surgery, intravitreal injections) or via trauma, though endogenous spread from systemic infections occurs in high-risk patients [1][3][16].
Population
Most prevalent after cataract surgery (0.08–0.68%) and intravitreal injections (0.008–1.4%) [1][2].
Higher risk in older adults, males, and those with diabetes, renal disease, or immunocompromise [2][4][12].
Endogenous cases often linked to bacteremia/fungemia (e.g., Klebsiella liver abscess, candidemia) [9][12].
Burden
Incidence: 0.09% post-intraocular surgery in Medicare populations [2]; mortality 0.97% in inpatients [4].
Visual outcomes: 53% experience major vision loss despite treatment; worse prognosis with virulent pathogens (e.g., Bacillus) [14][16].
Economic impact: Prolonged hospital stays, repeated procedures, and high costs of intravitreal therapies [3][10].
Prompt diagnosis and aggressive treatment are critical to optimizing outcomes [1][6].
Therapies
Intravitreal antibiotics (vancomycin + ceftazidime) ± corticosteroids; systemic antifungals (echinocandins/fluconazole) for endogenous cases [3][5][8].
Vitrectomy for severe cases (e.g., light perception vision, intraocular foreign bodies) to reduce microbial load [3][13].
Adjunctive topical antibiotics, vigilant monitoring, and early surgical intervention for trauma-related or refractory infections [1][9].
Categories: rare ophthalmic disorders
Research Papers
3,229 drug discovery papers about Endophthalmitis, with 2 first-in-class and 5 next-in-class emerging drug candidates forecasted to outperform the average preclinical success rate. Recent publications:
3,229 drug discovery papers about Endophthalmitis, with 2 first-in-class and 5 next-in-class emerging drug candidates forecasted to outperform the average preclinical success rate. Recent publications:
2026-08-13 | Visual Acuity Influences Visual Outcome in Endophthalmitis: A 10-Year Retrospective Observational Cohort Analysis.
Endophthalmitis is a severe, sight-threatening intraocular infection that may follow ophthalmic procedures or arise endogenously. Since the Endophthalmitis Vitrectomy Study (EVS, 1995), surgical and antimicrobial strategies have evolved. This study aimed to evaluate treatment approaches, microbial spectrum, and outcomes of endophthalmitis cases at the University Eye Clinic Innsbruck over the past decade. A retrospective observational cohort analysis of all patients treated for endophthalmitis between January 2013 and December 2023 was conducted. Cases were categorized as exogenous, endogenous, or keratitis-related. Data on etiology, treatment, time to intervention, microbial isolates, and best-corrected visual acuity (BCVA, logMAR) were assessed. Treatment included tap and inject, pars plana vitrectomy (PPV) within 24 h after presentation, or delayed surgery. Regression analyses identified predictors of visual outcome and re-intervention. A total of 118 eyes from 110 patients (median age 72 years) were included. Exogenous cases accounted for 60.2%, endogenous for 28.8%. Median BCVA at diagnosis was 2.3 logMAR, improving to 1.0 logMAR at 6 months. Pathogens were isolated in 58.5% of cases-mainly Staphylococcus epidermidis (57%) in exogenous and Candida albicans (20.6%) in endogenous infections. Median time to intervention in exogenous cases was 3.5 h. BCVA at diagnosis and timepoint were significantly associated with visual outcome over time (p < 0.001, respectively; exogenous cases only). Re-intervention was required in 78 eyes; hazard was significantly higher after delayed surgery in exogenous cases (HR of 5.7, 95% CI [2.9-11.1], p < 0.001 (n = 71, 39 re-interventions). Visual acuity remains the main prognostic factor for visual recovery. In exogenous endophthalmitis, delayed surgery is associated with a high re-intervention rate, which may be reduced by initial tap-and-inject treatment. Prospective studies are needed to establish optimal timing and treatment strategies.
2026-08-06 | An Injectable Dual Bacterial-Trapping Nanozyme Composite Hydrogel for Synergistic Antibacterial/Anti-Inflammatory Therapy of Endophthalmitis.
Bacterial endophthalmitis (BE) is characterized by severe intraocular bacterial infection and sustained inflammation. Current therapeutic efficacy is compromised by the passive diffusion-dominated drug release kinetics of conventional carriers, leading to inadequate bacterial clearance and frequent invasive injections. Herein, an injectable hydrogel is engineered to achieve a synergistic "trap-and-kill" and immunomodulatory therapy. The hydrogel matrix is constructed via dynamic Schiff base crosslinking between quaternized chitosan and oxidized dextran, providing excellent injectability and biocompatibility. The hydrogel integrates boronic acid-decorated cerium metal-organic frameworks (Ce-MOFs) within this dynamic polysaccharide network, possessing dual bacterial-trapping attributed to boronic acid-mediated bacterial surface covalent binding to surface cis-diols and electrostatic attraction. This "bacterial enrichment" effect overcomes the diffusion barrier, markedly enhancing the bactericidal efficiency of the encapsulated vancomycin, resulting in a reduction in the dosage to as low as 14-20% of the clinical amount, yet the effect remains comparable. Furthermore, leveraging the catalase- and superoxide dismutase-mimicking activities of Ce-MOFs, the hydrogel functions as a therapeutic nanozyme to scavenge excessive reactive oxygen species (ROS) and downregulate pro-inflammatory cytokines. Validated by comprehensive in vitro and in vivo models, this integrated platform demonstrates superior bacterial eradication and inflammation resolution, which presents an active, robust therapeutic strategy for those deep-seated implant-associated infections.
2026-08-02 | Twelve-month functional and structural outcomes of Candida endogenous endophthalmitis in immunocompetent patients: a longitudinal cohort study of an outbreak.
To characterize twelve-month visual outcomes, structural complications, and retinal pigment epithelium (RPE) dynamics stratified by initial lesion morphology in an iatrogenic, single-center outbreak of Candida endogenous endophthalmitis (EFE) among immunocompetent patients. This retrospective longitudinal cohort study included patients from a single-source outbreak. Of 26 eyes in the original cohort, 18 were classified with chorioretinal involvement and 8 with intraretinal or preretinal involvement. After excluding eyes with severe baseline destruction or loss to follow-up, 13 chorioretinal eyes and 8 intraretinal or preretinal eyes completed the twelve-month follow-up. Main outcome measures included best-corrected visual acuity (BCVA), complication rates, the incidence of secondary macular neovascularization (MNV) using optical coherence tomography angiography (OCTA), and longitudinal RPE lesion area changes quantified via optical coherence tomography (OCT). Although both groups experienced functional improvement after treatment, the chorioretinal group had significantly worse final BCVA at twelve months (median 0.80 versus 0.20 LogMAR; P = 0.005) and a higher overall complication burden (92.3% versus 25.0%; P < 0.001) than the intraretinal or preretinal group. Secondary MNV developed in 100.0% of evaluable eyes in the chorioretinal group (10/10; 95% CI, 69.2%-100.0%), whereas no MNV occurred in the intraretinal/preretinal group (0/8; 95% CI, 0.0%-36.9%; P < 0.001). In the chorioretinal group, the RPE lesion area increased during the first three months and subsequently decreased by month twelve, occurring concurrently with sustained BCVA improvement. Initial chorioretinal involvement was associated with poorer visual recovery and a markedly higher incidence of secondary MNV. The early expansion of RPE lesions alongside visual improvement likely reflects tissue remodeling and may be less suggestive of ongoing infection. These findings support routine OCT and OCTA surveillance and timely anti-vascular endothelial growth factor therapy for eyes with chorioretinal involvement.
2026-07-31 | Outcomes in patients with endophthalmitis and no light perception vision initially treated with intravitreal antibiotics
Abstract Background Management of endophthalmitis presenting with NLP (no light perception) vision remains poorly defined, with limited evidence guiding treatment decisions. We aim to investigate whether treatment with intravitreal antibiotics reduces the rate of enucleation or evisceration of eyes presenting with exogenous or endogenous endophthalmitis and NLP vision. Methods Retrospective chart review of patients who presented with endophthalmitis and NLP vision between 2010 and 2020 at a tertiary referral center. Main outcome measures were the proportion of patients receiving intravitreal antibiotics or enucleation/evisceration (ENEV) as initial treatment and the rate of globe preservation in patients who received intravitreal antibiotics. Results 28 eyes of 26 patients presented with endophthalmitis and NLP vision. The majority of eyes (18/28) were initially treated with intravitreal antibiotics with the aim of globe preservation. Of these 18 eyes, a majority (11/18) achieved globe preservation and the remainder underwent secondary ENEV. Eyes with endogenous and exogenous endophthalmitis that were treated with intravitreal antibiotics achieved similar rates of globe preservation (54% and 57%, respectively). After intravitreal antibiotics, vision in one eye improved to light perception and underwent pars plana vitrectomy to maintain vision. Ultimately, however, the final recorded visual acuity in all eyes was NLP. Additionally, two eyes that received intravitreal antibiotics eventually suffered from phthisical changes, although there was no pain associated with these cases. Conclusion In eyes with NLP vision and endophthalmitis, treatment with intravitreal antibiotics leads to a meaningful rate of globe preservation, however the medical decision making in these cases is complex, requiring consideration of the clinical scenario and the patient’s preferences.
2026-07-30 | Dropless Pars Plana Vitrectomy Using Intravitreal Decanted Triamcinolone and Moxifloxacin: Safety and Efficacy.
To evaluate the safety and efficacy of a dropless regimen using intravitreal decanted triamcinolone acetonide and moxifloxacin at the conclusion of pars plana vitrectomy (PPV), compared with standard postoperative topical therapy. This retrospective study included consecutive patients undergoing PPV at a tertiary retina center. The dropless cohort (May-October 2025) received intravitreal decanted triamcinolone (5 mg) and moxifloxacin (500 μg). The control cohort, operated during the preceding 6 months, received topical moxifloxacin 0.5% and prednisolone acetate 1%. Outcomes included intraocular inflammation, intraocular pressure (IOP), central subfield thickness (CST), cystoid macular edema (CME), and best-corrected visual acuity (BCVA). A prespecified subgroup analysis was performed for epiretinal membrane (ERM). 172 eyes were included (87 dropless, 85 topical). The dropless group demonstrated significantly less anterior chamber inflammation at week 2 (P = 0.0008) and at month 3 (P = 0.0223). Mean CST was lower at week 2 (P = 0.001), month 3 (P = 0.0009), and month 6 (P = 0.012). CME incidence was reduced (P < 0.001). BCVA improvement was greater in the dropless group at week 2 (+15 vs -2.5 ETDRS letters; P = 0.0003), month 3 (+25 vs +9.5 letters; P = 0.002), and month 6 (+20 vs +8 letters; P = 0.01). IOP was similar between groups, and no endophthalmitis occurred. Findings were consistent in the ERM subgroup. A dropless intravitreal regimen at the conclusion of PPV can be a safe and effective alternative to topical therapy, with reduced postoperative inflammation and CME and improved visual outcomes.
2026-08-13 | Visual Acuity Influences Visual Outcome in Endophthalmitis: A 10-Year Retrospective Observational Cohort Analysis.
Endophthalmitis is a severe, sight-threatening intraocular infection that may follow ophthalmic procedures or arise endogenously. Since the Endophthalmitis Vitrectomy Study (EVS, 1995), surgical and antimicrobial strategies have evolved. This study aimed to evaluate treatment approaches, microbial spectrum, and outcomes of endophthalmitis cases at the University Eye Clinic Innsbruck over the past decade. A retrospective observational cohort analysis of all patients treated for endophthalmitis between January 2013 and December 2023 was conducted. Cases were categorized as exogenous, endogenous, or keratitis-related. Data on etiology, treatment, time to intervention, microbial isolates, and best-corrected visual acuity (BCVA, logMAR) were assessed. Treatment included tap and inject, pars plana vitrectomy (PPV) within 24 h after presentation, or delayed surgery. Regression analyses identified predictors of visual outcome and re-intervention. A total of 118 eyes from 110 patients (median age 72 years) were included. Exogenous cases accounted for 60.2%, endogenous for 28.8%. Median BCVA at diagnosis was 2.3 logMAR, improving to 1.0 logMAR at 6 months. Pathogens were isolated in 58.5% of cases-mainly Staphylococcus epidermidis (57%) in exogenous and Candida albicans (20.6%) in endogenous infections. Median time to intervention in exogenous cases was 3.5 h. BCVA at diagnosis and timepoint were significantly associated with visual outcome over time (p < 0.001, respectively; exogenous cases only). Re-intervention was required in 78 eyes; hazard was significantly higher after delayed surgery in exogenous cases (HR of 5.7, 95% CI [2.9-11.1], p < 0.001 (n = 71, 39 re-interventions). Visual acuity remains the main prognostic factor for visual recovery. In exogenous endophthalmitis, delayed surgery is associated with a high re-intervention rate, which may be reduced by initial tap-and-inject treatment. Prospective studies are needed to establish optimal timing and treatment strategies.
2026-08-06 | An Injectable Dual Bacterial-Trapping Nanozyme Composite Hydrogel for Synergistic Antibacterial/Anti-Inflammatory Therapy of Endophthalmitis.
Bacterial endophthalmitis (BE) is characterized by severe intraocular bacterial infection and sustained inflammation. Current therapeutic efficacy is compromised by the passive diffusion-dominated drug release kinetics of conventional carriers, leading to inadequate bacterial clearance and frequent invasive injections. Herein, an injectable hydrogel is engineered to achieve a synergistic "trap-and-kill" and immunomodulatory therapy. The hydrogel matrix is constructed via dynamic Schiff base crosslinking between quaternized chitosan and oxidized dextran, providing excellent injectability and biocompatibility. The hydrogel integrates boronic acid-decorated cerium metal-organic frameworks (Ce-MOFs) within this dynamic polysaccharide network, possessing dual bacterial-trapping attributed to boronic acid-mediated bacterial surface covalent binding to surface cis-diols and electrostatic attraction. This "bacterial enrichment" effect overcomes the diffusion barrier, markedly enhancing the bactericidal efficiency of the encapsulated vancomycin, resulting in a reduction in the dosage to as low as 14-20% of the clinical amount, yet the effect remains comparable. Furthermore, leveraging the catalase- and superoxide dismutase-mimicking activities of Ce-MOFs, the hydrogel functions as a therapeutic nanozyme to scavenge excessive reactive oxygen species (ROS) and downregulate pro-inflammatory cytokines. Validated by comprehensive in vitro and in vivo models, this integrated platform demonstrates superior bacterial eradication and inflammation resolution, which presents an active, robust therapeutic strategy for those deep-seated implant-associated infections.
2026-08-02 | Twelve-month functional and structural outcomes of Candida endogenous endophthalmitis in immunocompetent patients: a longitudinal cohort study of an outbreak.
To characterize twelve-month visual outcomes, structural complications, and retinal pigment epithelium (RPE) dynamics stratified by initial lesion morphology in an iatrogenic, single-center outbreak of Candida endogenous endophthalmitis (EFE) among immunocompetent patients. This retrospective longitudinal cohort study included patients from a single-source outbreak. Of 26 eyes in the original cohort, 18 were classified with chorioretinal involvement and 8 with intraretinal or preretinal involvement. After excluding eyes with severe baseline destruction or loss to follow-up, 13 chorioretinal eyes and 8 intraretinal or preretinal eyes completed the twelve-month follow-up. Main outcome measures included best-corrected visual acuity (BCVA), complication rates, the incidence of secondary macular neovascularization (MNV) using optical coherence tomography angiography (OCTA), and longitudinal RPE lesion area changes quantified via optical coherence tomography (OCT). Although both groups experienced functional improvement after treatment, the chorioretinal group had significantly worse final BCVA at twelve months (median 0.80 versus 0.20 LogMAR; P = 0.005) and a higher overall complication burden (92.3% versus 25.0%; P < 0.001) than the intraretinal or preretinal group. Secondary MNV developed in 100.0% of evaluable eyes in the chorioretinal group (10/10; 95% CI, 69.2%-100.0%), whereas no MNV occurred in the intraretinal/preretinal group (0/8; 95% CI, 0.0%-36.9%; P < 0.001). In the chorioretinal group, the RPE lesion area increased during the first three months and subsequently decreased by month twelve, occurring concurrently with sustained BCVA improvement. Initial chorioretinal involvement was associated with poorer visual recovery and a markedly higher incidence of secondary MNV. The early expansion of RPE lesions alongside visual improvement likely reflects tissue remodeling and may be less suggestive of ongoing infection. These findings support routine OCT and OCTA surveillance and timely anti-vascular endothelial growth factor therapy for eyes with chorioretinal involvement.
2026-07-31 | Outcomes in patients with endophthalmitis and no light perception vision initially treated with intravitreal antibiotics
Abstract Background Management of endophthalmitis presenting with NLP (no light perception) vision remains poorly defined, with limited evidence guiding treatment decisions. We aim to investigate whether treatment with intravitreal antibiotics reduces the rate of enucleation or evisceration of eyes presenting with exogenous or endogenous endophthalmitis and NLP vision. Methods Retrospective chart review of patients who presented with endophthalmitis and NLP vision between 2010 and 2020 at a tertiary referral center. Main outcome measures were the proportion of patients receiving intravitreal antibiotics or enucleation/evisceration (ENEV) as initial treatment and the rate of globe preservation in patients who received intravitreal antibiotics. Results 28 eyes of 26 patients presented with endophthalmitis and NLP vision. The majority of eyes (18/28) were initially treated with intravitreal antibiotics with the aim of globe preservation. Of these 18 eyes, a majority (11/18) achieved globe preservation and the remainder underwent secondary ENEV. Eyes with endogenous and exogenous endophthalmitis that were treated with intravitreal antibiotics achieved similar rates of globe preservation (54% and 57%, respectively). After intravitreal antibiotics, vision in one eye improved to light perception and underwent pars plana vitrectomy to maintain vision. Ultimately, however, the final recorded visual acuity in all eyes was NLP. Additionally, two eyes that received intravitreal antibiotics eventually suffered from phthisical changes, although there was no pain associated with these cases. Conclusion In eyes with NLP vision and endophthalmitis, treatment with intravitreal antibiotics leads to a meaningful rate of globe preservation, however the medical decision making in these cases is complex, requiring consideration of the clinical scenario and the patient’s preferences.
2026-07-30 | Dropless Pars Plana Vitrectomy Using Intravitreal Decanted Triamcinolone and Moxifloxacin: Safety and Efficacy.
To evaluate the safety and efficacy of a dropless regimen using intravitreal decanted triamcinolone acetonide and moxifloxacin at the conclusion of pars plana vitrectomy (PPV), compared with standard postoperative topical therapy. This retrospective study included consecutive patients undergoing PPV at a tertiary retina center. The dropless cohort (May-October 2025) received intravitreal decanted triamcinolone (5 mg) and moxifloxacin (500 μg). The control cohort, operated during the preceding 6 months, received topical moxifloxacin 0.5% and prednisolone acetate 1%. Outcomes included intraocular inflammation, intraocular pressure (IOP), central subfield thickness (CST), cystoid macular edema (CME), and best-corrected visual acuity (BCVA). A prespecified subgroup analysis was performed for epiretinal membrane (ERM). 172 eyes were included (87 dropless, 85 topical). The dropless group demonstrated significantly less anterior chamber inflammation at week 2 (P = 0.0008) and at month 3 (P = 0.0223). Mean CST was lower at week 2 (P = 0.001), month 3 (P = 0.0009), and month 6 (P = 0.012). CME incidence was reduced (P < 0.001). BCVA improvement was greater in the dropless group at week 2 (+15 vs -2.5 ETDRS letters; P = 0.0003), month 3 (+25 vs +9.5 letters; P = 0.002), and month 6 (+20 vs +8 letters; P = 0.01). IOP was similar between groups, and no endophthalmitis occurred. Findings were consistent in the ERM subgroup. A dropless intravitreal regimen at the conclusion of PPV can be a safe and effective alternative to topical therapy, with reduced postoperative inflammation and CME and improved visual outcomes.
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Drug Discovery Landscape
3 orphan drug designations for Endophthalmitis.
3 orphan drug designations for Endophthalmitis.
Drug | Therapy type | Regulator | Orphan designation | Approval | Sponsor |
|---|---|---|---|---|---|
povidone iodine | small molecules | FDA | 2018-11-30 | — | Cumulus Pharmaceutical LLC |
povidone iodine | small molecules | FDA | 2017-11-27 | — | Veloce BioPharma LLC |
vancomycin | small molecules | FDA | 2012-12-27 | — | Fera Pharmaceuticals, LLC |
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