Clinical Profile and Outcomes of Patients with Endophthalmitis Treated with Pars Plana Vitrectomy: A Retrospective Study of 10 Years
DOI:
https://doi.org/10.48560/rspo.33271Keywords:
Endophthalmitis, Treatment Outcome, VitrectomyAbstract
INTRODUCTION: Endophthalmitis is a sight-threatening emergency that requires prompt diagnosis and treatment. In the last few years, the role of early vitrectomy in endophthalmitis has been reconsidered. This study aims to describe the clinical profile and outcomes in endophthalmitis patients undergoing pars plana vitrectomy (PPV) and evaluate the effects of early PPV.METHODS: Retrospective study of 13 eyes from 13 patients with clinical diagnosis of endophthalmitis treated with PPV at Hospital Pedro Hispano, Portugal, between September 2013 and August 2023. Demographics and clinical data were collected from the patients’ medical records.
RESULTS: The mean age of patients was 69.0 ± 2.5 years and 8 (61.5%) were male. Two cases (15.4%) of endogenous endophthalmitis in the setting of infectious endocarditis were observed. Eleven (84.6%) cases of exogenous endophthalmitis were observed: 5 (38.5%) after intravitreal injection, 2 (15.4%) after cataract surgery, 2 (15.4%) related to late complications of glaucoma surgery, 1 (7.7%) after phaco-vitrectomy, and 1 (7.7%) after penetrating trauma. Most patients presented an initial visual acuity (VA) of hand motion (58.3%). PPV was performed an average of 3.9 ± 1.2 days after admission. The final VA improved in the majority of patients (66.7%), with 38.5% of patients reaching a final VA ≥20/40, 23.0% reaching 20/200-20/50, and 38.5% ≤20/400. Patients submitted to early PPV in the first 48 hours from admission (N=7) showed a tendency for a more favorable final visual outcome compared with patients submitted to PPV >48 hours (100% vs 33.3% improved their vision and 42.9% vs 33.3% achieved a final VA ≥20/40, respectively).
CONCLUSION: The most common cause of endophthalmitis among our patients was postophthalmic surgery, which reinforces the importance of sterile techniques and proper patient education for alarm symptoms. Vitrectomy for endophthalmitis results in VA improvement in some cases, and early vitrectomy may provide more favorable outcomes.
Downloads
References
Lee CS, Khan M, Patrie J, Bajwa A, Shildkrot Y. Pars Plana Vitrectomy for Endophthalmitis: Microbiologic Spectrum and Clinical Outcomes. Ocul Immunol Inflamm. 2021;29:871–6. doi: 10.1080/09273948.2019.1698750.
Almanjoumi AM, Combey A, Romanet JP, Chiquet C. 23-gauge transconjunctival sutureless vitrectomy in treatment of post-operative endophthalmitis. Graefes Arch Clin Exp Ophthalmol. 2012;250:1367-71. doi: 10.1007/s00417-012-1926-7.
Almarzouki N, Alessa S, Raffa L. Clinical profile of patients with endophthalmitis: A 16 year retrospective, cross-sectional study at tertiary care hospital in Western Saudi Arabia. Niger J Clin Pract. 2021;24:1527.
Endophthalmitis Vitrectomy Study Group. Results of the Endophthalmitis Vitrectomy Study. A randomized trial of immediate vitrectomy and of intravenous antibiotics for the treatment of postoperative bacterial endophthalmitis. Endophthalmitis Vitrectomy Study Group. Arch Ophthalmol. 1995;113:1479–96.
Negretti GS, Chan W, Pavesio C, Muqit MM. Vitrectomy for endophthalmitis: 5-year study of outcomes and complications. BMJ Open Ophthalmol. 2020;5:e000423. doi: 10.1136/bmjophth-2019-000423.
Ho IV, Fernandez-Sanz G, Levasseur S, Ting E, Liew G, Playfair J, et al. Early pars plana vitrectomy for treatment of acute infective endophthalmitis. Asia Pac J Ophthalmol. 2019;8:3-7. doi: 10.22608/APO.2018414.
Dib B, Morris RE, Oltmanns MH, Sapp MR, Glover JP, Kuhn F. Complete and Early Vitrectomy for Endophthalmitis After Cataract Surgery: An Alternative Treatment Paradigm. Clin Ophthalmol. 2020;14:1945–54. doi: 10.2147/OPTH.S253228.
Chiquet C, Aptel F, Combey-de Lambert A, Bron AM, Campolmi N, Palombi K, et al. Occurrence and risk factors for retinal detachment after pars plana vitrectomy in acute postcataract bacterial endophthalmitis. Br J Ophthalmol. 2016;100:1388-92. doi: 10.1136/jophthalmol-2015-307359.
Day AC, Donachie PHJ, Sparrow JM, Johnston RL. The Royal College of Ophthalmologists’ National Ophthalmology Database study of cataract surgery: report 1, visual outcomes and complications. Eye. 2015;29:552–60. doi: 10.1038/eye.2015.3.
Moussa G, Bassilious K, Mathews N. A novel excel sheet conversion tool from Snellen fraction to LogMAR including ‘counting fingers’, ‘hand movement’, ‘light perception’ and ‘no light perception’ and focused review of literature of low visual acuity reference values. Acta Ophthalmol. 2021;99:e9635. doi: 10.1111/aos.14659.
Shao EH, Yates WB, Ho IV, Chang AA, Simunovic MP. Endophthalmitis: changes in presentation, management and the role of early vitrectomy. Ophthalmol Ther. 2021;10:877–90. doi: 10.1007/s40123-021-00406-6.
Rangel CM, Parra MM, Corrales MI, Garcia D, Sánchez-Ávila R, Varón CL, et al. Endophthalmitis In Ophthalmological Referral Centre In Colombia: Aetiology And Microbial Resistance. Cesk Slov Oftalmol. 2022;78:160–73. doi: 10.31348/2022/19.
Grzybowski A, Turczynowska M, Kuhn F. The treatment of postoperative endophthalmitis: should we still follow the endophthalmitis vitrectomy study more than two decades after its publication? Acta Ophthalmol. 2018;96:e651–4. doi: 10.1111/aos.13623.
Januschowski K, Boden KT, Szurman P, Stalmans P, Siegel R, Pérez Guerra N, et al. Effectiveness of immediate vitrectomy and intravitreal antibiotics for post-injection endophthalmitis. Graefes Arch Clin Exp Ophthalmol. 2021;259:1609-15. doi: 10.1007/s00417-021-05071-w.
Weber C, Stasik I, Herrmann P, Schmitz-Valckenberg S, Holz FG, Liegl R. Early vitrectomy with silicone oil tamponade in the management of postoperative endophthalmitis. J Clin Med. 2023;12:5097. doi: 10.3390/jcm12155097.
Blom K, Jørstad ØK, Faber RT, Stene‐Johansen I, Holberg‐Petersen M, Hermansen NO, et al. Primary vitrectomy or intravitreal antibiotics followed by early vitrectomy for acute endophthalmitis: A prospective observational study. Acta Ophthalmol. 2023;101:100–8. doi: 10.1111/aos.15207.
Brockhaus L, Goldblum D, Eggenschwiler L, Zimmerli S, Marzolini C. Revisiting systemic treatment of bacterial endophthalmitis: a review of intravitreal penetration of systemic antibiotics. Clin Microbiol Infect. 2019;25:1364-9. doi: 10.1016/j.cmi.2019.01.017.
Thulasidas M, Services G, Talwar D. Ciprofloxacin: Rationale for Use in Intraocular Infections. J Pharmacol Clin Toxicol. 2023;11:1171.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Revista Sociedade Portuguesa de Oftalmologia
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Do not forget to download the Authorship responsibility statement/Authorization for Publication and Conflict of Interest.
The article can only be submitted with these two documents.
To obtain the Authorship responsibility statement/Authorization for Publication file, click here.
To obtain the Conflict of Interest file (ICMJE template), click here
