Ten-Year Real-World Outcomes Of Intravitreal Antibiotics Alone, Deferred Vitrectomy, And Immediate Vitrectomy For Acute Post-Cataract Endophthalmitis

To evaluate visual outcomes in acute post-cataract endophthalmitis managed with intravitreal antibiotics (ivAB) alone, deferred vitrectomy (Vit), or primary Vit.

Retrospective cohort study of 80 eyes presenting within 6 weeks of cataract surgery between 2013–2023, each followed ≥3 months.

Eyes were grouped as: ivAB only (n=35), ivAB + deferred Vit (n=21), and primary Vit + ivAB (n=24). Treatment followed EVS-based triage: eyes with light perception (LP) or worse underwent immediate Vit; others received ivAB, followed by Vit if inadequate response at 48 hours. Microbiologic analysis and antibiotic sensitivity were performed on vitreous samples. Visual acuity and complication rates were assessed.

Baseline characteristics were similar across groups. At Day 30, visual acuity was better in the ivAB-only group (0.81±0.76) than ivAB + Vit (1.17±0.77) and primary Vit (1.32±0.76) (p=0.022). At 3 months, the ivAB-only group retained the best mean vision (0.77±0.78 vs 1.04±0.88 vs 1.22±0.85; p=0.12). Retinal detachment occurred more in primary Vit (20.8%) than in deferred Vit (4.8%) or ivAB-only (2.9%) (p=0.045). Repeat injections were avoided in 43% of ivAB-only eyes vs. 9.5% (ivAB + Vit) and 41.7% (primary Vit) (p=0.003). Core vitrectomy (OR: 2.20; 95% CI: 1.17–4.16), higher baseline IOP (OR: 1.09; p=0.02), and need for repeat injection (OR: 2.01; 95% CI: 1.21–3.62) predicted poor outcome (BCVA >1 logMAR).

Eyes with better than LP vision responded well to intravitreal antibiotics with deferred vitrectomy. Primary vitrectomy carried higher retinal detachment risk, and poorer outcomes were seen with LP vision or antibiotic failure, supporting a triaged, stepwise approach.