Purpose:
To compare visual outcomes of endophthalmitis following intravitreal injections (IVI) and cataract extraction (CE) by causative organism.
Methods:
Searches in Cochrane Central Register of Controlled Trials, MEDLINE, and Embase identified articles reporting visual outcome by causative organism in post-IVI and CE endophthalmitis cases from January 2010-February 2022. A random-effects meta-analysis compared visual improvement amongst endophthalmitis cases by causative organism.
Results:
85 out of 3317 retrieved studies were included. The highest degree of VA improvement in both post-IVI and post-CE endophthalmitis was seen in cases caused by coagulase-negative staphylococci (CONS), followed by gram-negative organisms, and other gram-positive organisms such as streptococci and enterococci. Culture negative cases showed more VA improvement than culture positive cases in post-IVI endophthalmitis. These results remained consistent when accounting for endophthalmitis treatment, IVI type, condition requiring IVI treatment, follow-up period and initial pre-procedural VA.
Conclusion:
CONS and gram-negative organisms show the most VA improvement in both post-IVI and post-CE endophthalmitis. Other gram-positive organisms such as streptococci and enterococci are associated with less visual improvement. This updated systematic review and meta-analysis reveals that the results of the Endophthalmitis Vitrectomy Study are consistent decades later despite advancements to surgical practices and evolution of microorganisms over time.