Vitrectomy may be pursued earlier in treatment of endophthalmitis with poor vision
Eyes with injection-related endophthalmitis with poor vision may benefit from pars plana vitrectomy upon presentation rather than a subsequent procedure, according to a study.
“Vitrectomy may therefore be considered earlier in treatment in patients with poor vision of hand motion or worse, especially given both the absence of clear treatment guidelines beyond the Endophthalmitis Vitrectomy Study, as well as the improvement in safety and techniques of the vitrectomy procedure in recent years,” Srinath Soundararajan said at the virtual Association for Research in Vision and Ophthalmology meeting.
Soundararajan and colleagues included 133 eyes of 130 consecutive patients diagnosed with presumed infectious endophthalmitis over a 9-year period at Duke Eye Center in a retrospective study. The researchers evaluated clinical presentation, management, etiology of endophthalmitis, visual outcomes, complications and microbiologic yield.
After intravitreal injection, 23 eyes had a diagnosis of presumed infectious endophthalmitis. The most common agent was aflibercept, used in 60.9% of diagnosed eyes. Upon presentation, 12 eyes underwent an aqueous tap and 11 underwent needle vitreous tap. No eyes underwent pars plana vitrectomy (PPV) upon presentation, but six underwent subsequent PPV after a mean follow-up of 64.5 days, Soundararajan said.
According to Soundararajan, seven eyes were culture-positive, with coagulase-negative Staphylococcus the most common in four cases.
The mean visual acuity of the cohort was 20/1145 at presentation compared with 20/113 at the 6-month follow-up, with patients gaining a mean 10 ETDRS lines, he said.
Eyes that underwent subsequent PPV had a significantly worse presenting visual acuity of 20/7129 compared with 20/601 for eyes with no subsequent PPV (P = .022). The same was seen at 6 months, with subsequent PPV eyes having a mean visual acuity of 20/1002 compared with 20/55 for eyes with no subsequent PPV (P = .00038).
Additionally, eyes presenting with a visual acuity of hand motion at 1 foot or worse were more likely to undergo subsequent PPV, Soundararajan said.
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Soundararajan S, et al. Management patterns and outcomes for intravitreal injection-related endophthalmitis. Presented at: Association for Research in Vision and Ophthalmology annual meeting; June 12, 2020 (virtual meeting).
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