New treatment paradigm for infectious endophthalmitis: Results from the Mexican Endophthalmitis Study Group Protocol 1 and 3

Abstract

Purpose : To report the visual results of a prospective, multicentric non-randomized, two-arms, study, intending to test a new treatment algorithm for infectious endophthalmitis

Methods : We enrolled patients with a clinical diagnosis of postoperative endophthalmitis. Treatment was decided according to the Mexican Endophthalmitis Study group treatment algorithm (Figure 1): Protocol 1 (P1): patients with visual acuity of 20/100 or better and/or less than 2+ of vitreous haze/cells at baseline were treated with intravitreal injections of moxifloxacin and dexamethasone every 48 hours (Max 3 doses). Protocol 3 (P3): Patients with visual acuity of 20/150 to light perception and/or more than 2+ vitreous haze/cells at baseline were prep for immediate vitrectomy (within the first 24 hours after diagnosis) and treated thereafter with repeated doses of intravitreal moxifloxacin and dexamethasone every 48 hours (Max 3 doses). All patients had a complete ophthalmological examination, clinical photographs, b-scan ultrasound, and vitreous cultures. All patients were followed daily until achieving resolution criteria, then weekly during the first month, and monthly thereafter for 9 months. Visual changes were analyzed with repeated measurements ANOVA, with a Holm-Bonferroni correction

Results : A total of 367 patients were enrolled (P1: 181, P3: 186). The mean BCVA at baseline, 3 months, and 9 months of follow-up in P1 (logMAR ± SE) was: 0.56 ± 0.01; 0.46 ± 0.04; and 0.33 ± 0.04 respectively (p<0.001). In P3 was: 1.69 ± 0.04; 0.95 ± 0.06; and 0.92 ± 0.07 respectively (p<0.001). The mean letter gains at the end of the follow-up in P1 was 12.1 ± 1.4 letters, and 35.3 ± 2.0 letters in P3. In P1, 64.1% (95%CI: 57.1%-71.0%) had a 3 or more lines vision improvement; 76.2% (95%CI: 70-82.4 %) achieved a final BCVA of 20/40 or better. In P3, 73.6% (95CI: 67.2-79.9%) had a 3 or more lines vision improvement, 32.8% (95%CI: 26-39.5%) achieved a final BCVA of 20/40 or better. The proportion of improvement in P1 and P3 was 0.32 and 0.59 respectively (p<0.001)

Conclusions : Our treatment algorithm optimizes the decision making process and yielded better visual results than ones historically published by the EVS. Pars plana vitrectomy improves visual outcome, with a better percentage of improvement and a higher proportion of patients achieving a 15-letter gain

This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.

 

Mex-ESG treatment algorithm