The Role of Subconjunctival Antibiotics as an Adjunct to Intravitreal Antibiotics in the Management of Acute Postoperative Endophthalmitis

Abstract

Abstract: : Purpose: To evaluate the efficacy of subconjunctival antibiotic injection as an adjunct to intravitreal antibiotics in the treatment of acute postoperative endophthalmitis following cataract extraction. Methods: A retrospective chart review of 62 patients treated for postoperative endophthalmitis following cataract extraction or secondary intraocular lens placement was conducted. Patients presented to the Medical College of Wisconsin between July 1991 and March 2002. All patients received intravitreal antibiotics following vitreous tap or pars plana vitrectomy. Forty-three of these patients received concomitant subconjunctival antibiotics (SC+ group) while 19 did not (no-SC group). Outcome measures included final visual acuity and visual improvement as measured by the change in logarithm of the minimum angle of resolution (logMAR). Comparison of categorical visual acuities was done using chi-square analyses, while that of continuous variables was done using analysis of variance. Any differences with a P < 0.05 were considered statistically significant. Results: Baseline characteristics between the two groups differed with respect to the number of patents presenting with light perception vision and the rate of vitrectomy. For the subgroup of patients presenting within 6 weeks of cataract surgery and with initial visual acuity of hand motions or better, baseline characteristics were similar with respect to presenting visual acuity, duration of symptoms, and rate of culture negativity between the SC+ and no-SC groups. In the SC+ group compared to no-SC group, respectively, the rate of obtaining final visual acuity of 20/50 or better was 62% vs. 67% (P = N.S.), and that for obtaining 20/200 or better was 94% vs. 95% (P = N.S.). An improvement in visual acuity (logMAR) of ≥ 1.0 log units was observed in 62% in the SC+ group and 61% in the no-SC group (P = N.S). The mean change in logMAR was -1.24 for the SC+ group versus -1.28 for the no-SC group (P = N.S). Conclusions: As an adjunct to intravitreal antibiotics, subconjunctival antibiotic injection did not appear to influence visual outcome in the treatment of acute post-cataract extraction endophthalmitis for patients with presenting visual acuity of hand motions or better.

Keywords: endophthalmitis • cataract