The treatment of postoperative endophthalmitis: should we still follow the endophthalmitis vitrectomy study more than two decades after its publication?

Grzybowski, Andrzej; Turczynowska, Magdalena; Kuhn, Ferenc

doi:10.1111/aos.13623

Cited by 42 publications

(35 citation statements)

References 19 publications

(27 reference statements)

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“…Nonetheless, it is currently critical in most cases that clinical judgment should be used to determine treatment on a case-by-case basis. Moreover, first-line IAI recommendations have changed after EVS was published and, some authors have proposed vitrectomy as a concomitant treatment of IAI, for the treatment of APIE [27][28][29].…”

Section: Treatment Of Acute Postoperative Infectious Endophthalmitis 71 Intravitreal Antibiotics and Other Pharmacologic Therapiesmentioning

confidence: 99%

Acute Postoperative Infectious Endophthalmitis: Advances in Diagnosis and Treatment

Mota¹,

Guerrero-Naranjo²,

Dalma-Weiszhausz³

et al. 2021

Infectious Eye Diseases - Recent Advances in Diagnosis and Treatment

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Acute postoperative infectious endophthalmitis remains one of the most dreaded complications of ophthalmic surgery. One of the keys to success in treating this complication is to make an early clinical diagnosis and, if possible, an etiologic diagnosis that can guide treatment with antibiotic therapy. Different antibiotic therapy modalities have emerged over the years that have made it possible to treat even resistant strains of various microorganisms that cause endophthalmitis. Another relevant advance made in the etiological diagnosis of endophthalmitis is the advent of molecular biology techniques, such as the real-time polymerase chain reaction, which can detect minimal amounts of the genetic material of the causative microorganism present in the vitreous in a short period of time, thus improving treatment outcomes with better-guided therapy with intravitreal antibiotics. Aside from advances in postoperative diagnosis methods, the surgical treatment of endophthalmitis has had significant improvements in vitrectomy techniques, and in many cases, it has been proposed as the first-line treatment concomitantly with intravitreal antibiotic therapy. Moreover, there is increasing evidence that prophylaxis with intracameral antibiotic therapy further decreases postoperative endophthalmitis incidence.

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Section: Treatment Of Acute Postoperative Infectious Endophthalmitis 71 Intravitreal Antibiotics and Other Pharmacologic Therapiesmentioning

confidence: 99%

Acute Postoperative Infectious Endophthalmitis: Advances in Diagnosis and Treatment

Mota¹,

Guerrero-Naranjo²,

Dalma-Weiszhausz³

et al. 2021

Infectious Eye Diseases - Recent Advances in Diagnosis and Treatment

View full text Add to dashboard Cite

show abstract

“…In cases where PPV is performed, the EVS did not recommend complete vitrectomy for fear of complications such as retinal tears. 16 Current approaches with earlier complete vitrectomy, 88 including removal of posterior cortical vitreous and vitreous membranes, likely leave smaller bacterial and toxin loads. The presence of newer microsurgical techniques that are safer and provide better long-term outcomes 88 could be grounds for updating the guidelines to broaden the use of PPV acutely.…”

Section: Pars Plana Vitrectomymentioning

confidence: 99%

“…16 Current approaches with earlier complete vitrectomy, 88 including removal of posterior cortical vitreous and vitreous membranes, likely leave smaller bacterial and toxin loads. The presence of newer microsurgical techniques that are safer and provide better long-term outcomes 88 could be grounds for updating the guidelines to broaden the use of PPV acutely. Other advances in vitreoretinal surgery include improved illumination, wide-angle viewing, corneal limbal vitrectomy techniques, 89 and intraocular endoscopes.…”

Section: Pars Plana Vitrectomymentioning

confidence: 99%

Infectious Endophthalmitis: Trends in Microbiology, Management, and Surgical Techniques

Keffer

Chin

Almeida³

2018

Journal of VitreoRetinal Diseases

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The purpose of this review is to provide an update on etiologies, preventive practices, management options, and surgical techniques for infectious endophthalmitis. Methods: A literature search was conducted for studies published over the past 5 years. Results: Endophthalmitis continues to be an uncommon but dangerous complication following cataract surgery. Recently, intravitreal injections have become heavily utilized as a treatment for various ocular diseases, leading to a greater incidence of postinjection infections. Likewise, long-term risk of endophthalmitis should always be a consideration following glaucoma surgery and implanted drainage devices. Although significant overlap exists for causative organisms among the different etiologies, more targeted studies are needed to better optimize treatment. There has been a lack of updates to treatment guidelines since the Endophthalmitis Vitrectomy Study was published in 1995. Despite promising outcomes seen with newer surgical techniques, the lack of randomized clinical trials represents a major barrier to widespread implementation of these approaches. Conclusions: Povidone-iodine prophylaxis remains the primary evidence-based technique for decreasing the rates of endophthalmitis following intraocular procedures. Intracameral antibiotics have gained momentum in recent years and represent a step forward in mitigating the risk of infection with cataract surgery, although some debate still exists. Newer surgical techniques for vitrectomy that improve visualization, minimize surgical trauma, and decrease operative time would benefit from large-scale randomized trials.

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“…And it is the first report in the U.S. to show substantially improved outcomes versus the EVS results, compiled during an era of relatively primitive vitrectomy. Below we describe our treatment concepts, developed during our career-long interest in endophthalmitis, 1,[4][5][6][7][8][9][10][11][12][13] and implemented in this series.…”

mentioning

confidence: 99%

Complete and early vitrectomy for endophthalmitis

Morris

Kuhn

2021

European Journal of Ophthalmology

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We recently co-authored a report on the ten-year (2007-2017) results achieved at our center (Retina Specialists of Alabama) in the treatment of Acute Post-Cataract (APCE). Of all eyes, 77.4% were initially treated with Complete and Early Vitrectomy (CEVE). Visual acuity of ≥20/40 was restored in 79% of all eyes versus 53% of eyes reported in the Endophthalmitis Vitrectomy Study. We believe that CEVE is the initial treatment of choice whenever the fundus is obscured by endophthalmitis vitreous opacity.

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The treatment of postoperative endophthalmitis: should we still follow the endophthalmitis vitrectomy study more than two decades after its publication?

Cited by 42 publications

References 19 publications

Acute Postoperative Infectious Endophthalmitis: Advances in Diagnosis and Treatment

Acute Postoperative Infectious Endophthalmitis: Advances in Diagnosis and Treatment

Infectious Endophthalmitis: Trends in Microbiology, Management, and Surgical Techniques

Complete and early vitrectomy for endophthalmitis

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