September 2016
Volume 57, Issue 12
Open Access
ARVO Annual Meeting Abstract  |   September 2016
A Comparison between Immediate Vitrectomy and Tap and Inject for Acute Endophthalmitis with Vision Greater Than Light Perception
Author Affiliations & Notes
  • Janelle Marie Fassbender
    Ophthalmology, University of Louisville, Louisville, Kentucky, United States
  • Shlomit Schaal
    Ophthalmology, University of Louisville, Louisville, Kentucky, United States
  • Footnotes
    Commercial Relationships   Janelle Fassbender, None; Shlomit Schaal, None
  • Footnotes
    Support  Unrestricted institutional grant from Research to Prevent Blindness
Investigative Ophthalmology & Visual Science September 2016, Vol.57, 6383. doi:
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    • Get Citation

      Janelle Marie Fassbender, Shlomit Schaal; A Comparison between Immediate Vitrectomy and Tap and Inject for Acute Endophthalmitis with Vision Greater Than Light Perception. Invest. Ophthalmol. Vis. Sci. 2016;57(12):6383.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : The Endophthalmitis Vitrectomy Study (EVS) was completed well before the era of minimally invasive vitrectomy surgery. EVS recommendation was to refrain from vitrectomy for patients with vision greater than light-perception. The purpose of this study was to evaluate the safety and efficacy of modern immediate vitrectomy for these patients.

Methods : A retrospective multi-site investigation was undertaken to review 62 charts of patients with diagnosis code endophthalmitis from January 2010 to October 2015. Nineteen of these patients were determined to have acute endophthlamitis following either cataract surgery or intravitreal injection. Main outcome measure was the comparison of visual outcome in patients receiving either initial vitreous tap + injection of intravitreal antibiotics (T&I group) or immediate vitrectomy with intravitreal antibiotics (VTX group).

Results : T&I group included 8 patients. VTX group included 11 patients. Groups were not different in terms of age, gender, time since initial procedure (within 2 weeks), or time to treatment (< 24 hours). Vitrectomy was either 23 or 25G. Antibiotics injected in both groups were ceftazidime (2.25mg/0.1cc) and vancomycin (1mg/0.1 cc). Pre-operative visual acuity for the T&I group was 1.71 ± 0.71 LogMar (20/1025 ± 20/103) compared to 2.43 ± 0.60 LogMar (Counting fingers ± 20/80) for the vitrectomy group (p = 0.06). Final visual acuity with follow up for an average of 6 weeks yielded visual acuity 0.9 ± 0.65 LogMar (20/159 ± 20/89) for the tap and inject group and 0.39 ± 0.24 LogMar (20/49 ± 20/35) for the vitrectomy group (p = 0.01). The majority of cases were culture negative with 3/6 and 3/11 positive in the tap and inject or vitrectomy groups, respectively.

Conclusions : Modern small gauge vitrectomy for acute endophthalmitis is safe and effective for patients with presenting visual acuity better than light perception. In this cohort, patients undergoing immediate vitrectomy had significantly better visual outcomes.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.

 

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