J Korean Ophthalmol Soc.  2018 Jan;59(1):37-43. 10.3341/jkos.2018.59.1.37.

Vitrectomy versus Intravitreal Antibiotic Injection to Treat Acute Endophthalmitis Developing after Cataract Surgery

• Kim JY
• Lee JE
• Pak KY

• KMID: 2401676
• DOI: http://doi.org/10.3341/jkos.2018.59.1.37

Abstract

PURPOSE
To compare the therapeutic efficacy of vitrectomy plus intravitreal antibiotic injection (vitrectomy group) with intravitreal antibiotic injection alone (antibiotic group) for eyes with acute endophthalmitis developed after cataract surgery with visual acuity of hand motion or better.
METHODS
In this retrospective chart review, we compared the visual acuities of 10 eyes of a vitrectomy group and 17 eyes of an antibiotic group.
RESULTS
We found no significant differences between the two groups in terms of age, comorbidities (diabetes, hypertension), time of symptom onset, time of diagnosis, type of systemic antibiotic prescribed, or positive culture rate. Mean baseline best-corrected visual acuity (BCVA) was similar in the two groups (2.17 vs. 1.96 logMAR; p = 0.60). Both groups exhibited significant improvements in mean BCVA after 2 months: from 2.17 to 0.81 logMAR in the vitrectomy group (p = 0.01) and from 1.96 to 0.76 logMAR in the antibiotic group (p = 0.002), but the final BCVA did not differ significantly between the two groups (0.81 vs. 0.76 logMAR, p = 0.75).
CONCLUSIONS
Both vitrectomy combined with intravitreal antibiotic injection and intravitreal antibiotic injection alone significantly improved visual acuity; the final BCVA did not differ between the two groups. Intravitreal antibiotic injection alone may be an effective first-line treatment for endophthalmitis in patients with initial visual acuity of hand motion or better.

Keyword

Acute endophthalmitis; Cataract surgery; Intravitreal antibiotic injection; Vitrectomy

MeSH Terms

Cataract*
Comorbidity
Diagnosis
Endophthalmitis*
Hand
Humans
Retrospective Studies
Visual Acuity
Vitrectomy*

Figure

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  Figure 1 Changes over time in best corrected visual acuity (BCVA) (logMAR). Compared with baseline, BCVA improved gradually over time in both groups of patients, but there were no differences between the two groups at each time after intervention. In logMAR visual acuity scale, smaller number means better visual acuity. logMAR = logarithm of minimum angle of resolution (0: Snellen 20/20, 1: Snellen 20/200, 2: Finger-counting, 3: Hand-motion); IVAI = intravitreal antibiotic injection; POD = postoperative day. *Mann Whitney U-test (Vitrectomy + IVAI vs. IVAI only groups); †Wilcoxon signed rank test in Vitrectomy + IVAI group (vs. Baseline); ‡Wilcoxon signed rank test in IVAI only group (vs. Baseline).

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