Vitrectomy versus Intravitreal Antibiotic Injection to Treat Acute Endophthalmitis Developing after Cataract Surgery

Abstract

Purpose:To compare the therapeutic efficacy of vitrectomy plus intravitreal antibiotic injection (vitrectomy group) with intravitreal antibiotic injection alone (antibiotic group) for eyes with acute endophthalmitis developed after cataract surgery with visual acuity of hand motion or better. Methods: In this retrospective chart review, we compared the visual acuities of 10 eyes of a vitrectomy group and 17 eyes of an antibiotic group. Results: We found no significant differences between the two groups in terms of age, comorbidities (diabetes, hypertension), time of symptom onset, time of diagnosis, type of systemic antibiotic prescribed, or positive culture rate. Mean baseline best-corrected visual acuity (BCVA) was similar in the two groups (2.17 vs. 1.96 logMAR; p = 0.60). Both groups exhibited significant improvements in mean BCVA after 2 months: from 2.17 to 0.81 logMAR in the vitrectomy group (p = 0.01) and from 1.96 to 0.76 logMAR in the antibiotic group (p = 0.002), but the final BCVA did not differ significantly between the two groups (0.81 vs. 0.76 logMAR, p = 0.75). Conclusions: Both vitrectomy combined with intravitreal antibiotic injection and intravitreal antibiotic injection alone significantly improved visual acuity; the final BCVA did not differ between the two groups. Intravitreal antibiotic injection alone may be an effective first-line treatment for endophthalmitis in patients with initial visual acuity of hand motion or better.

Clinical characteristics and risk factors for visual prognosis according to the types of infectious endophthalmitis

“…Furthermore, repeated intravitreal antibiotics injection can be a useful treatment for resistant types of endophthalmitis [ 63 ]. In this study, we observed that intravitreal antibiotics injection could be an effective treatment for endophthalmitis, as reported by Kim et al [ 62 ].…”

“…Contrastingly, some reports have shown no significant difference in final VA between vitrectomy and the use of intravitreal antibiotics injection [ 60 , 61 ]. Kim et al reported that there was no significant difference between vitrectomy and use of intravitreal antibiotics injection when the initial VA was better than hand movement; thus, intravitreal antibiotics injection can be a primary treatment for endophthalmitis [ 62 ]. Furthermore, repeated intravitreal antibiotics injection can be a useful treatment for resistant types of endophthalmitis [ 63 ].…”