Vitrectomy in acute endophthalmitis

Infective endophthalmitis remains a feared and devastating complication of intraocular surgery

Dermot McGrath

Published: Friday, September 6, 2019

[caption id="attachment_16382" align="alignleft" width="1024"]

Andrew Chang[/caption]

Modern microincisional vitrectomy surgery is effective in improving vision in patients presenting with acute endophthalmitis, Andrew Chang MD said at the EURETINA session on uveitis/endophthalmitis.

Infective endophthalmitis remains a feared and devastating complication of intraocular surgery including cataract surgery and increasingly post-intravitreal injections, said Dr Chang.

He noted that there has been an exponential rise in the number of intravitreal injections (IVI) and the risk of endophthalmitis in recent years. Furthermore, the spectrum of organisms causing endophthalmitis after intravitreal injections differed to those post cataract surgery, with post IVI infections leading to poorer visual outcomes.

Dr Chang presented results of a study of early vitrectomy for endophthalmitis from the Sydney Eye Hospital, Australia. A total of 64 consecutive patients underwent early vitrectomy within 72 hours of presentation with acute infective endophthalmitis.

The mean vision improved from 3.1 logMAR (hand motion) baseline to 1.02 logMAR at one year. Vision improved in 89% patients, and 42% of patients had a final vision of better than logMAR 0.477 (Snellen 6/18). Complications included postoperative retinal detachment in four of 64 eyes, and two of the 64 eyes were eviscerated.

“Advances in vitrectomy technology and instrumentation allows the option of earlier vitrectomy compared to traditional guidelines based on the Endophthalmitis Vitrectomy Study,” he concluded.