Rapid treatment of endophthalmitis with intravitreal antibiotics is associated with better vision outcomes

Abstract

Background To discover whether the timing of intravitreal antibiotics, from the time of presentation to injection, affects the visual outcomes of patients with endophthalmitis from all causes. Methods A retrospective study of consecutive patients managed at Auckland District Health Board between 1 January 2004 and 1 July 2021. The main outcome measure was final visual acuity at follow‐up and the proportion of subjects with severe vision loss (≤6/60). Results Three hundred and seventy‐four eyes were included in the study, with a median age of 69.7 years at presentation; 192 subjects (51.6%) were female. The median presenting visual acuity was hand movements and hypopyon was present in 194 subjects (51.9%). Cataract surgery was the most frequent aetiology in 115 subjects (30.7%), followed by intravitreal anti‐vascular endothelial growth factor injections in 89 subjects (23.8%) and endogenous endophthalmitis in 54 subjects (14.4%). Median time to injection of intravitreal antibiotics was 3.5 h (Interquartile range 2–6). On multivariate analysis, early treatment with intravitreal antibiotics was associated with better visual outcome, particularly for those treated within 2 h, while poor presenting visual acuity and culture‐positive endophthalmitis were associated with worse outcomes. Conclusion Rapid intravitreal antibiotic administration is associated with better final visual acuity outcomes, particularly for those receiving treatment within 2 h of presentation. Patients with severe vision loss on presentation, benefit the most with improved final visual acuity following expedited treatment.

Role of Antimicrobial Resistance in Outcomes of Acute Endophthalmitis

“…The fact that weekend presentations are also associated with retinal detachments could be reflective of either greater symptom severity or longer delay to initial presentation. Previous work by our research group has not observed any delay in treatment with weekend presentations nor a decreased likelihood of receiving a vitrectomy over the weekend [ 27 ].…”

“…Empiric treatment plays a crucial role in limiting vision loss by halting microbial proliferation and should not be delayed. In the maxim of “Time is Retina”, Michael et al, retrospectively reviewed 374 eyes with endophthalmitis and found that treatment within 2 h with intravitreal antibiotics was associated with a better final visual outcome [ 27 ]. Historically, dual therapy, with Vancomycin directed against Gram-positive organisms and either Amikacin or Ceftazidime against Gram-negative organisms, has been established as a rational choice to cover a heterogenous group of causative organisms [ 3 , 28 ].…”

Comment on: Safety of office-based lens surgery: a U.S. multicenter study

“…1 However, when endophthalmitis does occur, early presentation to services and timely initiation of intravitreal antibiotics is essential for achieving favorable visual outcomes. 2…”