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

Timing of Vitrectomy

A recent review of postprocedural endophthalmitis patients who underwent vitrectomy within 72 h of diagnosis demonstrated that patients with preoperative visual acuity of hand motions (HM) and light perception achieved similar visual gains that were significantly greater than those with count fingers (CF) or better visual acuity, although conclusions were limited based on this retrospective design.[36] A 2018 survey of retina specialists showed that 70% proceeded to vitrectomy in patients who demonstrate clinical worsening 48 h after administering intravitreal antibiotics.[38] Given the low rate of endophthalmitis after pars plana vitrectomy, it seems plausible that the vitreous may provide a medium for microorganism growth that requires surgical removal.

In a review by Negretti et al.[30] patients with postprocedural endophthalmitis who underwent vitrectomy less than seven days from diagnosis had significantly better final visual acuity compared with those who underwent vitrectomy greater than seven days from diagnosis. The authors postulate that in the acute phases of endophthalmitis, there is vitreous debris and opacification that responds well to vitrectomy. Over days to weeks, retinal ischemia, preretinal fibrosis, and retinal thinning and breaks may develop that negatively impact outcomes.[30] Vitrectomy for endophthalmitis is complex and complications must be considered prior to surgical intervention. Indeed, among those undergoing vitrectomy, approximately 25% will develop secondary retinal detachments, and nearly 6% of patients will undergo enucleation or evisceration.[39]