Endophthalmitis Management Study—A Prospective Randomized Clinical Trial on Postoperative Endophthalmitis Management in India: An Interim Analysis. Endophthalmitis Management Study Report #3

Abstract

Purpose: An interim analysis of the Endophthalmitis Management Study to examine the outcome of inflammation score (IS)–based treatment and antibiotic susceptibility. Design: A prospective randomized study. Patients and Methods: IS was measured on a 0–4 scale from presenting signs in 4 cardinal ocular tissues. The eyes with IS <10 received vitreous tap and intravitreal antibiotics, whereas eyes with IS ≥10 received vitrectomy and intravitreal antibiotics. These eyes were randomized to 2 intravitreal antibiotic combinations: (1) vancomycin and ceftazidime and (2) vancomycin and imipenem. Microbiology workup of undiluted vitreous included microscopy, culture-susceptibility, Sanger, and targeted next-generation sequencing. The clinical and microbiology outcomes were analyzed for advanced (IS = ≥20) and less advanced (IS = <10) endophthalmitis. Results: Interim analysis was performed after the Endophthalmitis Management Study recruited 56.85% (248/436) of patients and completed 54.6% (238/436) of microbiology workup. A 90-day follow-up was completed in 90.8% (168/185) of eligible people. In eyes with IS ≥20, the time to symptoms was shorter (5.8 ± 6.7 vs 8.5 ± 9.1 d; P = 0.015), and the need for additional treatment was higher (95.8% vs 53.1%; P = 0.0267). Good final vision was associated with good presenting vision (r = 0.30) and IS-based treatment decisions (r = 0.170). Microbiology positivity was 55.9%. Eyes with IS <10 had a higher Gram-positive cocci (33.9% vs 4.8%; P = 0.013) infection. Gram-positive cocci were most susceptible to vancomycin (95.7%), and Gram-negative bacilli to colistin (95.7%). Conclusions: Considering both IS and presenting vision, rather than only one of them, helps in making appropriate management decisions for acute postoperative endophthalmitis.

Pathobiology of Fungal Endophthalmitis: A Major Review

“…Accordingly, in their consequent studies, they reported erratic inflammation which increases with subsequent interventions which were mandatory in recalcitrant cases and indicated that the severity of the infection is directly correlated with higher IS values, underscoring the utility of this scoring system in assessing the progression of the disease and guiding treatment decisions. 8 These insights highlight the critical need for precise diagnostic tools and tailored therapeutic strategies for managing fungal endophthalmitis. Laboratory diagnosis primarily involves direct microscopic examination, culture on Sabouraud Dextrose Agar (SDA) and Potato Dextrose Agar (PDA), even though it does grow on blood agar, chocolate agar, and brain heart infusion broth.…”

“…Other drugs such as caspofungin and posaconazole showed resistant to 50% of the cases. 8 Since the majority of the cases are multidrugresistant, timely rescue of the vision in fungal endophthalmitis becomes increasingly challenging. Additionally, culture negative and recalcitrant cases pose a serious threat to timely diagnosis and intervention, resulting in greater influx of inflammatory cells disrupting the retinal architecture.…”

Early Vitrectomy for Endophthalmitis: Are EVS Guidelines Still Valid?

“…Notably, these preliminary findings indicate that the inflammation score serves as a valuable prognostic marker for the disease [15]. Indeed, within an as-yet-unpublished report, the authors engaged in this investigation have taken the bold step of suggesting that this specific parameter emerges as a superior instrument for directing clinical decision-making, particularly in the realm of early-stage disease management [16]. Table 1 provides a summary of the clinical trial studies conducted on the management of post-cataract surgery endophthalmitis.…”