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Marcel Kitsche, Lutz E Pillunat, Naim Terai; Evaluation of different therapeutical approaches on the clinical outcome of endophthalmitis patients. Invest. Ophthalmol. Vis. Sci. 2019;60(9):2040.
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Controversy exists about the therapy of choice in the treatment of endophthalmitis patients at the initial time point of consultation. A retrospective, observational clinical study was performed to investigate the effect of four therapeutical approaches: a conservative therapy (CONT) or a surgical therapy (intravitreal injection of antibiotics [IVI-ABX] or a pars plana vitrectomy [PPV] in combination with an anterior chamber irrigation/aspiration or a different therapy [DIFFT – e.g. anterior chamber irrigation, corneal crosslinking or perforating keratoplasty]) as the initial therapy.
We analyzed longitudinal data of all patients who were allocated to the ICD-10 diagnosis codes of endophthalmitis at the Department of Ophthalmology of the University of Carl Gustav Carus Dresden from 2006 to 2018. The clinical diagnosis of an endophthalmitis was ensured through the loss of vision by inflammation of the anterior chamber and the vitreous opacity in the B-scan sonography. Cross tabulations were used to evaluate the prevalence of the performed interventions. The numerical data are listed as mean values and standard errors of the mean.
Altogether 104 patients (49 women [age 72.5 ± 2.2 yrs]; 55 men [age 66.4 ± 2.5 yrs]) were included. As the initial therapy 11 patients received a CONT (10.6 %), 41 patients received an IVI-ABX (39.4 %), 42 patients underwent a PPV (40.4 %) and 10 were treated with DIFFT (9.6 %) as an initial therapy. Of all 104 patients, 30 patients (28.8 %) received no further surgery. However, 15 patients received an IVI-ABX (14.4 %), 42 underwent a PPV (40.4 %), 9 (8.7 %) a second PPV and 8 of them were treated by a DIFFT (7.7 %). Those 11 patients who received a CONT and those 10 patients who were treated by DIFFT initially deteriorated and underwent surgical intervention (either an IVI-ABX or a PPV) in the further course. 35 of the 41 patients (85.4 %) who received an IVI-ABX as the initial therapy underwent a follow-up-operation. In contrast, only 19 of the 42 patients (45.2 %) who received a PPV as the initial therapy underwent a follow-up-operation.
The results of the present study indicate that endophthalmitis patients who receive an IVI-ABX as an initial therapy deteriorate despite the injection. Hence we conclude that a PPV should be performed straightaway as the first-line therapy as early as possible.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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