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Visual outcomes poor after therapeutic pars plana vitrectomy in patients with endophthalmitis
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SAN FRANCISCO — In cases of acute endophthalmitis identified in a retrospective study, the most common setting for occurrence was after cataract surgery and the most common infective organism was Streptococcus, according to a scientific poster presented at the American Society of Retina Specialists meeting.
The retrospective, multicenter study included 97 patients who underwent pars plana vitrectomy (PPV) within 14 days of diagnosis of acute infectious endophthalmitis.
“Although the overall visual outcomes were poor with less than one-third of patients achieving 20/400 vision, the rate of globe loss was lower than may be expected given the virulence of organisms,” Jayanth Sridhar, MD, and colleagues wrote.
Only three patients (3.1%) had visual acuity of 20/400 or better at presentation; however, visual acuity at follow-up was 20/400 or better in 28 patients (28.9%), with mean logMAR visual acuity improving from 2.38 at presentation to 1.96 after surgery. Evisceration or enucleation was performed in three patients (3.1%).
Twenty-nine patients underwent cataract surgery before onset of infection.
Even though 70 patients (72.2%) initially underwent vitreous tap and intravitreal antibiotic injection, all patients ultimately underwent PPV. Average time from initial presentation to PPV was 2.3 days, with 67% of patients undergoing PPV within 48 hours.
Streptococcus species was identified as the causative agent in 26 of the 78 patients from whom positive intraocular cultures were obtained.
Neither underlying etiology nor timing of surgery significantly affected final visual acuity. – by Matt Hasson
Reference:
Sridhar J, et al. Microbiologic spectrum and visual outcomes of acute onset endophthalmitis undergoing therapeutic pars plana vitrectomy. Presented at: American Society of Retina Specialists annual meeting; Aug. 9-14, 2016; San Francisco.
Disclosure: Sridhar reports no relevant financial disclosures.