Anatomic and Functional Outcomes Following Treatment of Acute Endophthalmitis: 7 Year Experience of the Central Region of Portugal
DOI:
https://doi.org/10.48560/rspo.33231Keywords:
Anti-Bacterial Agents, Endophthalmitis/drug therapy, Endophthalmitis/surgery, Intravitreal Injections, VitrectomyAbstract
INTRODUCTION: Endophthalmitis is a rare but possibly catastrophic intraocular infection, potentially leading to blindness in the affected eye. The purpose of this study was to evaluate the outcomes of acute exogenous endophthalmitis, inferring on the role of pars plana vitrectomy (PPV) in the management of these patients, as well as to study the possible prognostic impact of different baseline and treatment related variables.MATERIAL AND METHODS: Retrospective observational study including patients that underwent antibiotic intraocular injection with/without PPV for the treatment of acute exogenous endophthalmitis at the Department of Ophthalmology of Centro Hospitalar e Universitário de Coimbra, between 2016 and 2022. Minimum follow-up time was 6 months. Demographic and clinical data were recorded and analyzed. Best corrected visual acuity (BCVA) was converted into logarithm of the minimum angle of resolution (LogMAR) for comparison purposes.
RESULTS: A total of 83 eyes of 83 patients (55.42% male) were included. Median age was 77 years (66-82). The two major causes of endophthalmitis were cataract surgery (48.15%) and intravitreal injections (45.68%). Median BCVA at presentation was 2.28 LogMAR (1.98-2.70; equivalent to hand motion). There was a significant improvement in BCVA at the last follow-up (p<0.001), with a median final BCVA of 0.80 LogMAR (0.20-2.28; equivalent to 20/125 Snellen). Almost all patients (98.80%) were treated with intravitreal antibiotic injections (IVIs) and 73.49% of patients were submitted to PPV. The final BCVA was significantly worse in the combined IVI and PPV when compared to the IVI alone group (p=0.026), however there were no significant differences in the variation of BCVA before and after treatment between these two groups (p=0.860). The most frequent complications were retinal detachment (13.3%) and need for evisceration (8.4%).
CONCLUSION: Although acute endophthalmitis represents a serious condition with possible catastrophic outcomes and poor visual prognosis, we found significant improvement in BCVA after appropriate treatment. Despite including one of the highest numbers of patients in recent single-center studies of this kind, it was not possible to confidently demonstrate superiority of the general use of PPV in the management of acute endophthalmitis in our study.
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