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Better visual outcome associated with early vitrectomy in the management of endophthalmitis
  1. Sarah Welch1,
  2. Riyaz Bhikoo1,
  3. Nancy Wang1,
  4. Martin J Siemerink1,
  5. William Shew1,
  6. Philip J Polkinghorne1,2,
  7. Rachael L Niederer1,2
  1. 1Department of Ophthalmology, Auckland District Health Board, Auckland, New Zealand
  2. 2Department of Ophthalmology, University of Auckland, Auckland, New Zealand
  1. Correspondence to Dr Rachael L Niederer, Ophthalmology, Greenlane Clinical Centre, Auckland 1051, New Zealand; dr_rachnz{at}yahoo.co.nz

Abstract

Aims To examine the role of early vitrectomy in the management of endophthalmitis from all causes.

Methods Retrospective study of 290 consecutive subjects diagnosed with endophthalmitis at Auckland District Health Board between 1 January 2006 and 31 July 2019. Main outcome measure was visual acuity at 9-month follow-up and proportion of subjects with severe vision loss (≤20/200).

Results Median age at presentation was 70.4 years and 151 subjects (52.1%) were women. Cataract surgery was the most common cause of endophthalmitis in 92 subjects (31.7%) followed by intravitreal injection in 57 (19.7%), endogenous endophthalmitis in 48 subjects (16.6%), non-surgical trauma in 42 subjects (14.5%), glaucoma surgery in 24 subjects (8.3%), vitrectomy in 22 subjects (7.6%) and corneal in 5 subjects (1.7%). Culture was positive in 136 (46.9%) with gram-positive organisms most common (76.5%). Early vitrectomy was performed in 82 subjects (28.3%). Median visual acuity at 9 months was 20/100 (IQR 20/30 to light perception), and severe vision loss occurred in 100 (43.5%). Retinal detachment occurred in 35 eyes (12.1%) and 26 eyes were enucleated. On multivariate analysis, younger age, poor presenting visual acuity and culture-positive endophthalmitis were associated with worse outcomes, and early vitrectomy was associated with better outcomes.

Conclusions Early vitrectomy (within 24 hours) is associated with better visual outcomes at 9 months, while younger age, poor presenting visual acuity and culture-positive endophthalmitis are associated with poorer visual acuity outcomes.

  • infection
  • inflammation
  • treatment surgery
  • vitreous

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Footnotes

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This study received audit approval from the Auckland District Health Board review committee (A+7868) and adhered to the tenets of the Declaration of Helsinki.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available.

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