Evaluation of Outcomes of Acute Cataract Surgery-Related Endophthalmitis Using a Novel Management Algorithm Based on...

Area of Science:

• Ophthalmology
• Infectious Diseases
• Surgical Outcomes

Background:

• Acute endophthalmitis (AE) following cataract surgery is a serious complication that can lead to vision loss.
• Timely and appropriate treatment is crucial for optimizing visual outcomes in AE patients.
• Existing treatment algorithms may not fully address the nuances of AE severity and management urgency.

Purpose of the Study:

• To develop and evaluate a treatment algorithm for acute endophthalmitis (AE) after cataract surgery.
• To introduce and validate the Acute Cataract surgery-related Endophthalmitis Severity (ACES) score for guiding management decisions.
• To assess the impact of the ACES score on visual outcomes in AE patients.

Main Methods:

• Retrospective, single-center, non-randomized interventional study.
• Development and application of the novel ACES score to stratify AE severity.
• Patients were categorized based on ACES score (≥3 for urgent pars plana vitrectomy [PPV] within 24 hours, <3 for non-urgent PPV).
• Evaluation of best-corrected visual acuity (BCVA) at 6 months or longer, comparing outcomes based on adherence to ACES recommendations.

Main Results:

• A total of 150 patients with AE were analyzed.
• Patients adhering to ACES recommendations for immediate PPV (score ≥3) achieved significantly better final BCVA (median 0.18 logMAR) compared to those who deviated (median 0.70 logMAR) (P < 0.01).
• For patients where urgent PPV was not indicated by the ACES score (<3), no significant difference in final BCVA was observed between those who followed the recommendation and those who deviated (P = 0.19).

Conclusions:

• The ACES score shows potential as a valuable tool for guiding urgent management decisions in post-cataract surgery AE.
• The score may help clinicians determine the necessity of immediate pars plana vitrectomy.
• Implementing the ACES score could lead to improved visual outcomes by standardizing and optimizing AE treatment.