Abstract
Purpose :
To describe if treatment patterns for endophthalmitis after cataract surgery in the IRIS® Registry are in line with evidence-based guidelines established by the 1995 Early Vitrectomy (VIT) Treatment Study (EVS) which showed that patients who present with light perception vision (LP) have better visual outcomes with immediate VIT compared to those with better vision.
Methods :
Using the American Academy of Ophthalmology IRIS Registry, patients undergoing cataract surgery between 2014 and 2022 (CPT codes), presenting with endophthalmitis (ICD 10 code) within 42 days post-cataract surgery, and having a record of being treated with VIT or vitreous tap with antibiotic injection (TAP) on the same or following day of endophthalmitis diagnosis were identified. Cofactors assessed included age, sex, race, ethnicity, geographic region, insurance status, and visual acuity on the day of endophthalmitis diagnosis were summarized and compared between patients treated with VIT or TAP.
Results :
Of the 2,425 patients who met the inclusion criteria, 14% (345) underwent VIT and 86% (2,080) underwent TAP. 80% of patients (1946) presented with endophthalmitis within 14 days from cataract surgery (median = 6 days). Notably, 66% (173/263) of the patients presenting with LP vision underwent TAP instead of VIT (Fig. 1). In a multivariable logistic regression model, receiving VIT instead of TAP was positively associated with poor vision at endophthalmitis presentation (LP – OR, 5.3 [CI: 2.9-10.5]; CF,HM – OR 1.8 [CI: 1.0-3.6]) vs. [20/20-20/40] vision; Asian vs. White race (OR, 2.6 [CI: 1.2-5.1]); Hispanic vs. Non-Hispanic ethnicity (OR, 1.9 [CI, 1.0-3.2]); living in the West (OR, 1.5 [CI, 1.1-2.2]) and Midwest (OR- 1.4 [CI, 1.0-2.0]) (vs. South). The remaining covariates (age, sex, and insurance coverage) were not significantly associated with increased risk of VIT (p> 0.05).
Conclusions :
This IRIS Registry analysis revealed differences between the EVS randomized controlled clinical trial recommendations and current real-world treatment patterns for endophthalmitis post-cataract surgery. Further studies are needed to identify the reasons for these differences.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.