Complete and Early Vitrectomy for Endophthalmitis After Cataract Surgery: An Alternative Treatment Paradigm
Received 5 May 2020
Accepted for publication 11 June 2020
Published 8 July 2020 Volume 2020:14 Pages 1945—1954
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 2
Editor who approved publication: Dr Scott Fraser
Bernard Dib, 1– 4 Robert E Morris, 1– 4 Matthew H Oltmanns, 1– 4 Mathew R Sapp, 1– 4 Jay P Glover, 5 Ferenc Kuhn 2, 6, 7
1Retina Specialists of Alabama, Birmingham, AL, USA; 2Helen Keller Foundation for Research and Education, Birmingham, AL, USA; 3University of Alabama at Birmingham (UAB), Department of Ophthalmology, Birmingham, AL, USA; 4UAB Callahan Eye Hospital, Birmingham, AL, USA; 5Retina Consultants of Nashville, Nashville, TN, USA; 6Milos Eye Hospital, Belgrade, Serbia; 7Zagorskiego Eye Hospital, Krakow, Poland
Correspondence: Robert E Morris
Retina Specialists of Alabama, 2208 University Blvd, Ste. 101, Birmingham, AL 35233, USA
Purpose: In this study, we report the treatment outcomes of complete and early vitrectomy for endophthalmitis (CEVE) after cataract surgery as the predominate initial treatment, accompanied by systemic antibiotics and retreatment of persistent or recurrent purulence (CEVE+).
Patients and Methods: Clinical features and microbiological factors were retrospectively reviewed in 62 eyes of 62 patients who were treated for acute postcataract endophthalmitis (APCE) occurring within three weeks of cataract surgery at Retina Specialists of Alabama, between 2007 and 2017.
Results: Visual acuity on presentation included light perception (LP) in 18 eyes (29%) and hand motion (HM) in 23 eyes (37%). Initial treatment was maximum possible vitrectomy in 48 eyes (77%) and tap-and-inject in 14 eyes (23%), with 38 eyes (61%) receiving two or more treatments. Cultures for the first intervention were positive in 49 eyes (79%) and virulent in 18 eyes (29%). At a median follow-up time of five months, final visual acuity was ≥ 20/40 in 49 eyes (79%), between 20/50 and 5/200 in seven eyes (11%), and < 5/200 in six eyes (10%). Virulence was the strongest predictor of poor visual outcome. Retinal detachment occurred in four eyes (6%), likely from necrotic retinal defects in each case.
Conclusion: Complete and early vitrectomy is a safe and effective initial treatment for APCE. When accompanied by systemic antibiotics and retreatment (CEVE+) of recurrent media opacification, it improves recovery of 20/40 or better visual acuity by approximately 50% compared to a predominantly tap-and-inject treatment paradigm. We recommend CEVE for fundus-obscuring APCE (∼ 75% of all cases) whenever the view is inadequate to rule out macular distress.
Keywords: endophthalmitis, postcataract endophthalmitis, vitrectomy, tap and inject, TAP, VIT, EVS, APCE
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