Diabetes and postoperative endophthalmitis in the endophthalmitis vitrectomy study

To determine whether there was a different response to vitrectomy and tap/biopsy with or without systemic antibiotic treatment in the Endophthalmitis Vitrectomy Study and whether the signs and symptoms of endophthalmitis differ between diabetic and nondiabetic patients.

A multicenter clinical trial in which patients with acute post-cataract extraction endophthalmitis were randomly assigned in a 2 x 2 factorial design to vitrectomy or tap/biopsy, in each case with or without intravenous antibiotics, and followed up for 9 months. Outcome measures included visual acuity assessed in standardized fashion.

Fifty-eight of 420 study patients had diabetes. Diabetic patients had slightly worse vision and ocular media at the baseline assessment. Only 39% of diabetic patients compared with 55% of nondiabetic patients achieved 20/40 final vision. Both diabetic and nondiabetic patients with initial light perception (LP)-only vision had better visual results with immediate vitrectomy. For those with better than LP baseline vision, patients with diabetes achieved visual acuity of 20/40 more often with vitrectomy (57%) than with tap/biopsy (40%), but this difference was not statistically significant. Patients without diabetes did equally well with vitrectomy or tap/biopsy.

For patients with better than LP vision, tap/biopsy is appropriate for those without diabetes. A clinical trial of a sufficient number of diabetic patients with better than LP vision is necessary to determine the best management for this group. At present, initial vitrectomy or tap/biopsy are reasonable approaches for diabetic patients with better than LP vision.