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

Jung Yup Kim; Joo Eun Lee; Kang Yeun Pak

doi:10.3341/jkos.2018.59.1.37

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Kim, Lee, and Pak: Vitrectomy versus Intravitreal Antibiotic Injection to Treat Acute Endophthalmitis Developing after Cataract Surgery

Original Article

Journal of the Korean Ophthalmological Society 2018; 59(1): 37-43.

Published online: 12 January 2018

DOI: https://doi.org/10.3341/jkos.2018.59.1.37

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

Jung Yup Kim, MD¹, Joo Eun Lee, MD, PhD², Kang Yeun Pak, MD¹

¹Department of Ophthalmology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea.

²J Eye Center, Busan, Korea.

Address reprint requests to Kang Yeun Pak, MD. Department of Ophthalmology, Haeundae Paik Hospital, #875 Haeun-daero, Haeundae-gu, Busan 48108, Korea. Tel: 82-51-797-2310, Fax: 82-51-797-2030, pky0402@naver.com

Received 28 September 2017 Revised 30 October 2017 Accepted 1 January 2018

The Korean Ophthalmological Society

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Acute endophthalmitis, Cataract surgery, Intravitreal antibiotic injection, Vitrectomy

Figures and Tables

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).

Table 1

Baseline patient demographics and clinical characteristics

Values are presented as mean ± SD unless otherwise indicated.

IVAI = intravitreal antibiotic injection; BCVA = best corrected visual acuity; logMAR = logarithm of minimum angle of resolution (0: Snellen 20/20, 1: Snellen 20/200, 2: Finger-counting, 3: Hand-motion).

^*Fisher's exact test; ^†Mann Whitney U-test.

Table 2

Results of vitreous cultures

IVAI = intravitreal antibiotic injection; CNS = coagulase negative staphylococcus.

^*Fisher's exact test.

Table 3

Summary of logistic regression analysis of factors affecting final BCVA (n = 27)

BCVA = best corrected visual acuity; OR = odds ratio; C.I. = confidence interval.

^*Vitrectomy + Intravitreal antibiotic injection vs. Intravitreal antibiotic injection alone.

Notes

^{Conflicts of Interest} The authors have no conflicts to disclose.

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