Vitrectomy for endophthalmitis: 5-year study of outcomes and complications

Abstract

Background/aims: To analyse the complications and outcomes of vitrectomy surgery for endophthalmitis.

Methods: This was a retrospective case series. All cases that underwent 23-gauge vitrectomy surgery for endophthalmitis at a tertiary centre between 1 February 2013 and 1 February 2018 were included. Main outcome measures were as follows: visual acuity (VA) at final visit and post-vitrectomy complications.

Results: 33 patients were included in the study with 20 men and 13 women, average age 63 years. Main post-surgical causes for endophthalmitis included phacoemulsification (n=9), trabeculectomy (n=5), intravitreal injection (n=5), corneal graft (n=4), vitreoretinal surgery (n=3) and endogenous endophthalmitis (n=6). Average follow-up was 18 months (SD 14). 21/33 (64%) patients had baseline perception of light VA. Analysis of exogenous endophthalmitis cases only demonstrated: mean LogMAR VA improved significantly from 2.68 to 1.66 (p=0.001). At final follow-up, 12% had VA of 6/12 or better, and 28% had VA of 6/36 or better. Vitrectomy within 7 days resulted in improved final VA outcomes (1.49 vs 2.16 LogMAR, p=0.032). Complications included retinal detachment (24.2%), macular hole (3%), hypotony (6%), suprachoroidal haemorrhage (3%) and enucleation/evisceration (6%).

Conclusion: Vitrectomy for endophthalmitis leads to VA gains in some cases. Surgical outcomes may be improved with early vitrectomy performed within 7 days of the initial event for exogenous endophthalmitis. Patients should be advised of the potential risk of severe complications with/and without surgery.

Keywords: infection; inflammation; retina; treatment surgery.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1

VA outcomes (a): bar chart comparing mean VA (LogMAR) before and after vitrectomy for whole group. Mean VA pre-op is 2.6 and significantly lower final VA at 1.65 (p=0.0001) (B): Cluster bar chart comparing visual outcomes of exogenous and endogenous causes of endophthalmitis. (C): Bar chart showing mean VA outcome for patients with exogenous endophthalmitis. Mean VA pre-op is 2.67 and significantly lower final VA at 1.65 (p=0.0001). VA, visual acuity.

Figure 2

VA results and timing of vitrectomy surgery: (a) scatter plot showing distribution of VA gain for duration to vitrectomy in days. The best fit line shows downward trend of visual gain with delaying vitrectomy. (B) Cluster bar comparing VA between patients having vitrectomy 7 days or less CF. More than 7 days, there was a statistically significant difference for final visual outcome 1.43 (≤7 days) versus 2.27(>7 days) p=0.02. VA, visual acuity.