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Vitrectomy an effective treatment for endophthalmitis
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FORT LAUDERDALE, Fla. — There are advantages to treating endophthalmitis with therapeutic vitrectomy, which is often reserved for the advanced cases or recurrences, according to a speaker here.
“The benefits are that it reduces the microbial load and toxins. It removes foreign vitreous membranes. It allows an abundant specimen for cultures and improves visualization of follow-up of these patients,” Harry W. Flynn Jr. MD, said at the Retina World Congress.
Harry W. Flynn Jr.
However, vitrectomy takes specialized equipment, an operating room setting, a possible delay in getting to the operating room and anesthesia-related risks, Flynn said.
In the 1990s, the Endophthalmitis Vitrectomy Study followed 420 patients with acute postoperative endophthalmitis, comparing treatment with immediate vitrectomy with intravenous antibiotics. In patients with light perception vision, vitrectomy was clearly better with a three-times increased chance of achieving 20/40 vision or better, a two-times increased rate of achieving 20/100 vision or better and a decreased chance of poor vision, Flynn said.
In patients with hand motion vision, there was no difference in visual outcomes between therapeutic vitrectomy and a tap and inject therapy, according to the presentation.
“The study did not conclude that vitrectomy is contraindicated in this group of patients,” he said.
When performing vitrectomy for endophthalmitis, Flynn noted that a 6-mm infusion cannula should be used to avoid suprachoroidal effusion, and the uninvolved crystalline lens should be preserved during the procedure. – by Robert Linnehan
Reference:
Flynn Jr. HW. Vitrectomy in the endophthalmitis patient. Presented at: Retina World Congress; Feb. 23-26, 2017; Fort Lauderdale, Fla.
Disclosure: Flynn reports no relevant financial disclosures.