International Practice Patterns in Postsurgical Endophthalmitis
Ophthalmology Retina, June 2019
Solima et al. set out to study current practice patterns for the management of eyes with acute endophthalmitis following cataract surgery and intravitreal injections. They also assessed the likelihood that an affected eye would be managed with pars plana vitrectomy (PPV) or intravitreal injections of antibiotics. They found that PPV was frequently performed in these eyes, regardless of the presenting vision—and that eyes with increased vitreous opacification were commonly managed with PPV.
For this retrospective nonrandomized study, the researchers evaluated data on 237 eyes with acute endophthalmitis. The information was provided by 57 retina specialists in 28 countries in Africa, Asia, Europe, and South America. Outcome measures included rates of PPV, repeat intravitreal injections, and adjunctive therapeutic regimens.
Of the 237 eyes diagnosed with acute endophthalmitis, 153 (64.6%) had undergone cataract surgery, 35 (14.8%) had received intravitreal injections, and 29 (12.2%) were diagnosed following a previous PPV. The remaining 20 eyes (8.4%) had undergone other intraocular surgeries, including glaucoma and cornea procedures.
With regard to treatment, all eyes received intravitreal antibiotics on the day of presentation. PPV was performed within the first week of presentation in 176 eyes (74.3%), while the remaining 61 eyes (25.7%) received antibiotics only. Data were available on the choice of antibiotic for 210 of the 237 eyes—of these, 191 received a combination of two drugs, most commonly vancomycin and ceftazidime (183 eyes). Early PPV was more likely in those eyes that developed endophthalmitis following cataract surgery and in those in which the disc and macula were not visualized. In addition, PPV was not limited to eyes with baseline light perception vision.
The authors emphasized that these results need to be interpreted with caution, given the study’s uncontrolled retrospective design and absence of data from U.S. retina practices, among other factors. (Also see related commentary by Bernard H. Doft, MD, in the same issue.)
The original article can be found here.