Endophthalmitis After Cataract Surgery: An Update on Recent Advances

Travis J. Peck; Samir N. Patel; Allen C. Ho


Curr Opin Ophthalmol. 2021;32(1):62-68. 

In This Article

Role of Vitrectomy

Another notable result of the recent EVRS survey was that 82% of patients underwent pars plana vitrectomy for endophthalmitis after cataract surgery within five days of seeking treatment.[28] The EVS demonstrated that early vitrectomy was only superior to intravitreal injection of antibiotics in patients with light perception or worse vision after cataract surgery,[11] which constituted 24% of the patients in this study.[28] This is in contrast to data from the United States, in which only 25% of surgeons performed early vitrectomy on patients with postcataract endophthalmitis and hand motions or better vision.[29] Although vitrectomy is utilized for non-EVS indications, the increased rate also may be in part because of exclusion of eyes with poor corneal or anterior segment clarity from the EVS, as these eyes are more likely to require vitrectomy.[11]

In addition to the indications for vitrectomy changing, the smaller gauge instruments now commonly used may allow for a peripheral and much more complete vitrectomy than was performed with the 20-ga technique used in the EVS.[30,31] Advantages of smaller gauge vitrectomy include preservation of the conjunctiva, less surgically induced astigmatism, and less ocular redness.[30,32,33] Currently, there are no prospective studies directly comparing visual outcomes of endophthalmitis patients undergoing 20 versus 23-ga vitrectomy. Some retrospective reviews of patients undergoing 23-ga vitrectomy for postprocedural endophthalmitis have shown excellent outcomes with 91,[34] 83,[32] and 80%[33] reaching a final visual acuity of 20/40 or better. It is, however, difficult to analyze these results, as preoperative visual acuity varied or was not reported and indications and timing of surgery vary across studies. Other studies demonstrate less favorable results with 40%[35] and 23%[36] achieving final visual acuity of 20/40, but these include patients with other ocular comorbidities. A 10-year review found that small-gauge vitrectomy is associated with similar visual outcomes to 20-ga vitrectomy in endophthalmitis, and there were no differences in rates of culture growth between techniques.[37]