Optimal management of postoperative endophthalmitis and results of the Endophthalmitis Vitrectomy Study

The Endophthalmitis Vitrectomy Study was a multicenter randomized clinical trial. A total of 420 patients who had developed acute endophthalmitis after cataract surgery were randomly assigned to undergo vitrectomy or tap and biopsy and to receive either systemic antibiotics (ceftazidime and amikacin) or no systemic antibiotics. At 9 months patients were assessed for final visual acuity and media clarity. There was no difference in final visual acuity or media clarity whether or not systemic antibiotics were used. Patients who presented with hand motion acuity or better did not show a benefit from immediate vitrectomy. However, patients who presented with light-perception-only visual acuity had substantial benefit over immediate vitrectomy, with a threefold (33% vs 11%) increased frequency of achieving 20/40 vision or better, double the frequency of achieving 20/100, and a decrease by half in the frequency of severe visual loss to less than 5/200. These differences were statistically significant.