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Endogenous endophthalmitis in the setting of Covid-19 infection: A Case Series.

PURPOSE
To describe endogenous endophthalmitis in the setting of Covid-19 pneumonia.


METHODS
Patients recovering from Covid-19 pneumonia who presented to our department with any or all of the following complaints: pain, watering, redness and decreased vision were identified. All relevant data were collected for analysis.


RESULTS
Three patients with endogenous endophthalmitis were identified. All patients had been treated for Covid-19 pneumonia and had received Remdesivir and systemic steroids therefor; 2/3 received tocilizumab. All patients received vitreous biopsy, vitrectomy and intraocular antibiotic injection. Patient 1 demonstrated K.pneumoniae in blood culture, K.pneumoniae and E.coli in urine culture, and K.pneumoniae in vitreous fluid, while patients 2 and 3 demonstrated S.maltophilia and Methicillin Resistant S.Aureus in the blood and nasopharyngeal culture respectively. Correspondingly, the same organism was cultured from vitreous in patients 2 and 3. The visual acuity at last follow up in patients 1-3 was 20/100, 20/80 and 20/40 respectively. The probable source of infection was identified in each as renal calculi, dental caries and the pharynx respectively. Real time polymerase chain reaction demonstrated the presence of SARS CoV-2 in the vitreous fluid of patient 1.


CONCLUSION
We report good outcomes of early intervention for endogenous endophthalmitis in the setting of Covid-19 infection. We also document the presence of SARS-CoV-2 in vitreous.