Early Micro-incisional Pars Plana Vitrectomy for the treatment of Acute Infective Endophthalmitis: The Sydney Eye Hospital Experience

Abstract

Purpose : Acute-onset infectious endophthalmitis (IE) remains one of the most devastating complications and challenges faced in ophthalmology. Lately, there has been a trend towards early vitrectomy for the management of acute endophthalmitis.
We performed a retrospective, interventional clinical study to evaluate the efficacy and safety of early micro-incisional pars plana vitrectomy (PPV) for the treatment of patients with acute-onset infective endophthalmitis.

Methods : Retrospective chart review of all consecutive patients who presented with suspected acute infective endophthalmitis and underwent early PPV between 2009 and 2013 at Sydney Eye Hospital.

Results : 64 patients met the inclusion criteria. Median age was 77.5 years (range 43-92, ±11.4). The inciting event was phacoemulsification and intraocular lens implant in 34 patients (53%), intravitreal injections in 23 (36%), trabeculectomy in 2 (3%), endogenous in 2 (3%) and the remaining 3 followed vitrectomy, lens exchange and globe rupture. The visual acuity improved from mean baseline logMAR 3.1 to 1.02 at 1 year, with 42% achieving final VA equal to or better than logMAR 0.477. Final visual acuity in culture negative patients was logMAR 0.65 while the VA in culture positive cases was logMAR 1.22 (p value 0.01). Endophthalmitis post cataract surgery had a final VA of logMAR 0.65 while VA post intravitreal injection was logMAR 1.42 (p. value 0.002). Intraoperative retinal detachment (RD) was found in 6 patients (9.4%) and 4 patients (6.2%) had an RD postoperatively. Evisceration was required in 2 patients (3%), epiretinal membrane was found in 6 patients (9.4%), postoperative hypotony in 1 patient (1.6%) and ocular hypertension in 4 patients (6.2%).

Conclusions : Patients with acute infective endophthalmitis undergoing early PPV experience VA improvement in the majority of cases. Negative cultures and endophthalmitis post cataract surgery were factors that led to better final visual outcome. The rate of intraoperative and posteroperative RD is of concern and needs to be further assessed.

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