Early and complete vitrectomy versus tap and inject in acute post cataract surgery endophthalmitis presenting with hand motion vision; a quasi-experimental study

Abstract

Background Based on endophthalmitis vitrectomy study, intravitreal injection of antibiotics is preferred for initial management of cases of acute post cataract surgery endophthalmitis (APCE) with presenting vision of hand motions (HM). This study aimed to compare outcomes of early and complete vitrectomy (VIT) and vitreous tap and antibiotic injection (T&I) in cases of APCE presented with vision of HM. Methods In this prospective study, cases of APCE with vision of HM between 2018 and 2020 were enrolled. According to the time of presentation, the patients were arranged into two groups (VIT vs. T&I). Demographic data, elapsed time to developing endophthalmitis, past medical history, microbiology results, complications, and final visual acuity were recorded and analyzed. Results Seventy-six eyes of 76 patients were enrolled. Fifty-three eyes underwent T&I and twenty-three were arranged into the VIT group. Past medical history of 34.2% of patients was significant for diabetes mellitus. There was a statistically significant lower logMAR in VIT group compared to T&I group (diff = 0.14, 95% CI: 0.04 to 0.24, P-value = 0.007). The comparison of the diabetic and non-diabetic patients in both groups showed that the visual outcome was better in non-diabetic cases compared to the diabetic subjects. There was no statistically significant difference between the diabetic and non-diabetic groups regarding the superiority of procedure. Conclusion Based on our results, we could recommend that it’s maybe better to do early and complete vitrectomy as the initial management of APCE with the vision of HM. Past medical history of diabetes mellitus is not a determining factor for choosing initial management between vitrectomy and antibiotic injection.

IMMEDIATE VITRECTOMY vs TAP AND INJECT IN EYES WITH ACUTE POSTCATARACT ENDOPHTHALMITIS AND VISUAL ACUITY ≥HM

“…8 Inadequate clearing of bacteria with intravitreal injections alone may be the reason for the need for more reinterventions with T&I. 4,5,12 We noted almost similar improvement in media clarity in both groups at the final follow-up. Again, this could be because almost 40% of the eyes in the initial tap and injection group underwent secondary PPV.…”

“…They noted a significant difference in median gain in the visual acuities between the two groups in favor of early PPV ( P = 0.02). More recently, Tabatabaei et al 5 in a prospective nonrandomized study demonstrated significantly better visual outcomes with early PPV compared with T&I at a 6-month follow-up. This study only included eyes presenting with HM vision, and the results corroborate well with our study.…”

“…8 Inadequate clearing of bacteria with intravitreal injections alone may be the reason for the need for more reinterventions with T&I. 4,5,12…”

Timely vitrectomy without intraocular lens removal for acute endophthalmitis after cataract surgery

“…Vitrectomy for endophthalmitis has several advantages for patients, such as removing the infected organism, toxins and the infected vitreous that can cause subsequent retinal detachment [17] . Previous studies have shown that vitrectomy with silicone oil tamponade is preferable for post-surgery endophthalmitis [18][19][20][21] . Complete and early clearance of purulence and toxins is the most critical procedure for endophthalmitis, which will promptly halt and reverse potentially devastating damage to the eyes.…”

“…Complete and early clearance of purulence and toxins is the most critical procedure for endophthalmitis, which will promptly halt and reverse potentially devastating damage to the eyes. Complete and early vitrectomy was the initial treatment of choice and recommended by recent studies compared with the tap-and-inject process in the Endophthalmitis Vitrectomy Study (EVS), with 79% of eyes achieving ≥20/40 visual acuity in a recent study compared to 53% in the EVS, especially for those whose initial visual acuity was light perception only [18][19][20][21] . Various factors have been described that influence the prognosis of APCE, such as microorganism virulence and treatment [22][23] .…”