Outcomes of Post-Cataract Surgery Endophthalmitis Treated Without Microbial Cultures

Abstract

Purpose : To evaluate outcomes of eyes with post-cataract surgery endophthalmitis that were managed without microbial cultures.

Methods : This retrospective, single-center comparative study identified all cases of endophthalmitis after cataract surgery presenting between February 1, 2014 to May 1, 2020 using billing records. All eyes were treated with intravitreal antibiotics and a vitreous or aqueous tap or vitrectomy. Endophthalmitis cases were divided into the “culture group” if specimens were sent for microbiologic sampling or into the “no culture group” if intraocular specimens were not sent for microbiologic sampling. Each case was reviewed to determine visual acuity outcomes, secondary complications, and need for other procedures. Data was analyzed using IBM SPSS 25 Statistics, Armonk, NY, USA.

Results : Of the 173 endophthalmitis cases identified, 148 (86%) were in the “culture group” and 25 (14%) were in the “no culture group” (Table 1). At endophthalmitis presentation, eyes in the “culture group” had mean logMAR VA of 2.22 [~20/3319] compared to 1.86 [~20/1449] for eyes in the “no culture group” (p=0.061). At final follow up, mean logMAR visual acuity was 1.07 [approximately 20/235] for eyes in the “culture group” compared to 0.51 [~20/65] for the “no culture group” (adjusted difference 0.56; 95% confidence interval = 0.05 – 1.06, p=0.032) (Table 2). Eyes in the “culture group” required a subsequent pars plana vitrectomy in 42/148 (28%) cases compared to 5/25 (20%) cases in the “no culture group” (p=0.38). Fifteen of 148 (10%) eyes in the “culture group” developed secondary retinal detachments compared to 0 in the “no culture group” (p=0.132).

Conclusions : Intravitreal antibiotics without microbiologic cultures may be an acceptable treatment strategy to manage endophthalmitis after cataract surgery when immediate access to a microbiologic facility is not available.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.

 

Table 1. Clinical characteristics and secondary outcomes of patients with endophthalmitis after cataract surgery who underwent vitreous tap & injection of antibiotics versus those who received intravitreal antibiotics only.

 

Table 2. Visual acuity outcomes in eyes with endophthalmitis after cataract surgery that underwent vitreous tap & injection of antibiotics versus eyes that received intravitreal antibiotics only without microbiologic sampling.