Early vitrectomy for exogenous endophthalmitis following surgery

Area of Science:

• Ophthalmology
• Infectious Diseases
• Surgical Management

Background:

• Endophthalmitis is a severe intraocular infection, often following surgery or trauma, posing a significant risk to vision.
• Prompt diagnosis and treatment are critical for managing this sight-threatening emergency.

Purpose of the Study:

• To evaluate the effectiveness of combined pars plana vitrectomy and intravitreal antibiotics versus standard vitreous tap and intravitreal antibiotics for acute exogenous endophthalmitis.

Main Methods:

• A systematic search of multiple databases (CENTRAL, MEDLINE, Embase, etc.) was conducted up to May 2022.
• Included were randomized controlled trials (RCTs) comparing pars plana vitrectomy with intravitreal antibiotics against vitreous tap with intravitreal antibiotics.
• Primary outcomes included visual acuity changes, need for further surgery, quality of life, and adverse events.

Main Results:

• A single RCT, published 27 years ago with 420 participants, met the inclusion criteria.
• No statistically significant difference in visual acuity was found between pars plana vitrectomy and vitreous tap groups at three months (very low-certainty evidence).
• Low-certainty evidence indicated a similar need for additional surgical procedures between the groups; adverse events were reported in both arms.

Conclusions:

• The current evidence from a single, older RCT suggests no difference in visual acuity outcomes between pars plana vitrectomy and vitreous tap for exogenous endophthalmitis.
• There is a clear need for new, high-quality randomized controlled trials to investigate the role of primary vitrectomy, considering advancements in surgical techniques.