Early Vitrectomy for Post-Injection Endophthalmitis: an IRIS^® Registry Analysis

Abstract

Purpose : To determine if early pars plana vitrectomy (PPV) versus intravitreal injection of antibiotics alone had better visual outcomes for patients diagnosed with endophthalmitis after anti-vascular endothelial growth factor (anti-VEGF) injections

Methods : Using the American Academy of Ophthalmology IRIS^® Registry (Intelligent Research in Sight), a retrospective cohort analysis was conducted of post-injection endophthalmitis patients from 2016 to 2020. Inclusion criteria were endophthalmitis diagnosis (“diagnosis”) within 1 to 28 days after anti-VEGF injection and a recorded visual acuity (VA) at baseline (≤ 30 days before diagnosis), on the day of diagnosis (or any time from diagnosis to treatment), and 5 to 12 months post-treatment. Patients were placed into the “injection” treatment group if they underwent intravitreal injection of antibiotics alone and the “early vitrectomy” group if they had PPV plus injection of intravitreal antibiotics within two days of diagnosis. Patients were excluded if they had cataract surgery during the study, received intravitreal steroids ≤ 30 days before endophthalmitis, or had intermediate/posterior uveitis or cystoid macular edema. We created a 1:1 matched cohort using Mahalanobis Distance Matching, accounting for the differences in VA at baseline and diagnosis between the two treatment groups. A multiple linear regression model tested the association of treatment type on final visual outcomes.

Results : There were 935 patients in the “injection” group and 109 in the “early vitrectomy” group who fulfilled the inclusion and exclusion criteria. We matched 218 patients with similar VA at baseline and diagnosis (109 who had “injection” and 109 who had “early vitrectomy”). Among all matched patients, the median logMAR VAs were: 0.32 at baseline, 0.88 at diagnosis, and 0.57 post-treatment. Post-treatment VA was significantly associated only with VA before endophthalmitis (p<0.001) and VA at diagnosis of endophthalmitis (p<0.001). There were no statistically significant differences in the visual outcomes between the two matched treatment groups.

Conclusions : In this cohort analysis of the IRIS Registry, there was no significant difference in final VA outcomes between patients receiving intravitreal injection of antibiotics alone and those also treated with early PPV for post-injection endophthalmitis.

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

 

Result of the Multiple Linear Regression on Post-Treatment VA