Acute postoperative endophthalmitis after cataract operation: result of early vitrectomy within 24 hours of presentation

Objectives To evaluate result of early pars plana vitrectomy (PPV) within 24 hours of presentation for acute postoperative endophthalmitis after cataract operation, and to determine factors that predict visual outcome. Methods Consecutive patients who developed acute postoperative endophthalmitis wi...

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Bibliographic Details
Published in:	Eye (London) Vol. 37; no. 11; pp. 2344 - 2350
Main Authors:	Iu, Lawrence Pui Leung, Chan, Ho Yan, Li, Gabriel Ka Hin, Ho, Mary, Mak, Andrew Chun Yue, Wong, Posey Po Yin, Kam, Ka Wai, Chen, Li Jia, Brelen, Marten, Young, Alvin Lerrmann
Format:	Journal Article
Language:	English
Published:	London Nature Publishing Group UK 01-08-2023 Nature Publishing Group
Subjects:	692/699/255 692/699/3161 Anti-Bacterial Agents Antibiotics Cataract Cataracts Endophthalmitis Endophthalmitis - therapy Humans Infections Laboratory Medicine Medicine Medicine & Public Health Ophthalmology Pharmaceutical Sciences/Technology Postoperative Complications - surgery Retina Retinal detachment Retinal Detachment - surgery Retrospective Studies Streptococcus Streptococcus infections Surgery Surgical Oncology Treatment Outcome Vitrectomy
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Summary:	Objectives To evaluate result of early pars plana vitrectomy (PPV) within 24 hours of presentation for acute postoperative endophthalmitis after cataract operation, and to determine factors that predict visual outcome. Methods Consecutive patients who developed acute postoperative endophthalmitis within 6 weeks after cataract operation were reviewed. Patients were divided into two groups for analysis: (1) those receiving PPV within 24 hours of presentation (early PPV group), and (2) those receiving initial intravitreal antibiotics only without PPV within 24 hours of presentation (IVA group). Results Out of 41,411 cataract operations, 22 eyes developed acute postoperative endophthalmitis. Presenting VA was hand-movement or worse in 72.7%. The most common organisms were Staphylococcus (40.9%), Streptococcus (13.6%) and Enterococcus (13.6%). 22.7% of eyes had good final VA ≥ 20/30 and 27.3% had poor final VA < 20/400. Early PPV group had significantly lower rate of requiring additional treatments to control infection (25% versus 80%, P = 0.030), higher rate of retinal detachment (25% versus 0%, P = 0.221) and similar final logMAR VA (1.08 ± 1.08 versus 0.80 ± 0.80, P = 0.489) compared to IVA. Multivariate linear regression analysis showed that worse final VA was significantly associated with Streptococcus ( ß = 1.92, P = 0.007) and retinal detachment ( ß = 1.72, P = 0.005) but not with early PPV ( P = 0.225). Conclusion Early PPV was superior to initial intravitreal antibiotics alone as it required fewer additional treatments to control infection. Visual outcome was similar between early PPV and initial intravitreal antibiotics alone despite high number of poor presenting VA of light-perception in early PPV group. Streptococcal infection and retinal detachment were major poor prognostic factors for vision.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0950-222X 1476-5454 1476-5454
DOI:	10.1038/s41433-022-02347-1