Intravitreal Antibiotics With Early Vitrectomy Can Save Vision in Acute Endophthalmitis

In cases of acute endophthalmitis, when time is of the essence, primary intravitreal antibiotics and early vitrectomy (PIAEV) can stand in for primary vitrectomy (PV), according to a study published in Acta Ophthalmologica. The research shows PIAEV combined with polymerase chain reaction (PCR)-based diagnostics allows for vitrectomy in acute endophthalmitis and that patients can achieve clinically meaningful improvement in best-corrected visual acuity (BCVA). 

The researchers conducted a prospective, comparative observational study of acute endophthalmitis cases admitted to a regional vitreoretinal service spanning 18 months to compare outcomes of cases managed with either PV or PIAEV (vancomycin and ceftazidime) combined with PCR-based diagnostics.

The researchers collected microbiology samples either before or after administration of intravitreal antibiotics and analyzed the samples with broad-range 16S PCR and culture.

A total of 41 endophthalmitis cases (all unilateral) were included in the study; 20 in the PV group, (14 women and 6 men, mean age 77.8±8.9 years), and 21 in the PIAEV group (12 women and 9 men, mean age of 71.2±13.2 years).

The researchers observed clinically meaningful improvement in BCVA of at least 15 letters at 3 months in 79% of cases treated with PV and 71% of cases treated with PIAEV (P =.58). They found that 58% of cases had culture- and PCR-positive samples  and 18% of cases were culture-negative but PCR-positive (P =.02) and use of PCR increased the diagnostic yield both before and after administration of intravitreal antibiotics.

“Primary vitrectomy or primary injection of intravitreal antibiotics locally followed by admission for vitrectomy centrally allowed for early vitrectomy for all cases of acute endophthalmitis in a large region,” researchers explain. “By combining culture with PCR in connection with the vitrectomy procedure, intravitreal antibiotics could be injected before microbiological sampling, thereby improving the door-to-treatment time without sacrificing microbial identification.”

Limitations of the study included the observational design, lack of a conservatively managed control group for comparison, and incomplete patient records regarding symptom onset.

Reference

Blom K, Jørstad ØK, Faber RT, et al. Primary vitrectomy or intravitreal antibiotics followed by early vitrectomy for acute endophthalmitis: A prospective observational study.Acta Ophthalmol.  Published online June 25, 2022. doi:10.1111/aos.15207