Complete and Early Vitrectomy for Endophthalmitis After Cataract Surgery: An Alternative Treatment Paradigm

Bernard Dib,1– 4 Robert E Morris,1– 4 Matthew H Oltmanns,1– 4 Mathew R Sapp,1– 4 Jay P Glover,5 Ferenc Kuhn2,6,7 1Retina Specialists of Alabama, Birmingham, AL, USA; 2Helen Keller Foundation for Research and Education, Birmingham, AL, USA; 3University of Alaba...

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Autores principales:	Dib B, Morris RE, Oltmanns MH, Sapp MR, Glover JP, Kuhn F
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2020
Materias:	endophthalmitis postcataract endophthalmitis vitrectomy tap and inject tap vit evs apce Ophthalmology RE1-994
Acceso en línea:	https://doaj.org/article/2dc28016459c46c6bbc56a0119f8eeb1
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spelling	oai:doaj.org-article:2dc28016459c46c6bbc56a0119f8eeb12021-12-02T10:18:32ZComplete and Early Vitrectomy for Endophthalmitis After Cataract Surgery: An Alternative Treatment Paradigm1177-5483https://doaj.org/article/2dc28016459c46c6bbc56a0119f8eeb12020-07-01T00:00:00Zhttps://www.dovepress.com/complete-and-early-vitrectomy-for-endophthalmitis-after-cataract-surge-peer-reviewed-article-OPTHhttps://doaj.org/toc/1177-5483Bernard Dib,1– 4 Robert E Morris,1– 4 Matthew H Oltmanns,1– 4 Mathew R Sapp,1– 4 Jay P Glover,5 Ferenc Kuhn2,6,7 1Retina Specialists of Alabama, Birmingham, AL, USA; 2Helen Keller Foundation for Research and Education, Birmingham, AL, USA; 3University of Alabama at Birmingham (UAB), Department of Ophthalmology, Birmingham, AL, USA; 4UAB Callahan Eye Hospital, Birmingham, AL, USA; 5Retina Consultants of Nashville, Nashville, TN, USA; 6Milos Eye Hospital, Belgrade, Serbia; 7Zagorskiego Eye Hospital, Krakow, PolandCorrespondence: Robert E MorrisRetina Specialists of Alabama, 2208 University Blvd, Ste. 101, Birmingham, AL 35233, USAEmail rmorris@retinanetwork.comPurpose: In this study, we report the treatment outcomes of complete and early vitrectomy for endophthalmitis (CEVE) after cataract surgery as the predominate initial treatment, accompanied by systemic antibiotics and retreatment of persistent or recurrent purulence (CEVE+).Patients and Methods: Clinical features and microbiological factors were retrospectively reviewed in 62 eyes of 62 patients who were treated for acute postcataract endophthalmitis (APCE) occurring within three weeks of cataract surgery at Retina Specialists of Alabama, between 2007 and 2017.Results: Visual acuity on presentation included light perception (LP) in 18 eyes (29%) and hand motion (HM) in 23 eyes (37%). Initial treatment was maximum possible vitrectomy in 48 eyes (77%) and tap-and-inject in 14 eyes (23%), with 38 eyes (61%) receiving two or more treatments. Cultures for the first intervention were positive in 49 eyes (79%) and virulent in 18 eyes (29%). At a median follow-up time of five months, final visual acuity was ≥ 20/40 in 49 eyes (79%), between 20/50 and 5/200 in seven eyes (11%), and < 5/200 in six eyes (10%). Virulence was the strongest predictor of poor visual outcome. Retinal detachment occurred in four eyes (6%), likely from necrotic retinal defects in each case.Conclusion: Complete and early vitrectomy is a safe and effective initial treatment for APCE. When accompanied by systemic antibiotics and retreatment (CEVE+) of recurrent media opacification, it improves recovery of 20/40 or better visual acuity by approximately 50% compared to a predominantly tap-and-inject treatment paradigm. We recommend CEVE for fundus-obscuring APCE (&sim; 75% of all cases) whenever the view is inadequate to rule out macular distress.Keywords: endophthalmitis, postcataract endophthalmitis, vitrectomy, tap and inject, TAP, VIT, EVS, APCEDib BMorris REOltmanns MHSapp MRGlover JPKuhn FDove Medical Pressarticleendophthalmitispostcataract endophthalmitisvitrectomytap and injecttapvitevsapceOphthalmologyRE1-994ENClinical Ophthalmology, Vol Volume 14, Pp 1945-1954 (2020)
institution	DOAJ
collection	DOAJ
language	EN
topic	endophthalmitis postcataract endophthalmitis vitrectomy tap and inject tap vit evs apce Ophthalmology RE1-994
spellingShingle	endophthalmitis postcataract endophthalmitis vitrectomy tap and inject tap vit evs apce Ophthalmology RE1-994 Dib B Morris RE Oltmanns MH Sapp MR Glover JP Kuhn F Complete and Early Vitrectomy for Endophthalmitis After Cataract Surgery: An Alternative Treatment Paradigm
description	Bernard Dib,1– 4 Robert E Morris,1– 4 Matthew H Oltmanns,1– 4 Mathew R Sapp,1– 4 Jay P Glover,5 Ferenc Kuhn2,6,7 1Retina Specialists of Alabama, Birmingham, AL, USA; 2Helen Keller Foundation for Research and Education, Birmingham, AL, USA; 3University of Alabama at Birmingham (UAB), Department of Ophthalmology, Birmingham, AL, USA; 4UAB Callahan Eye Hospital, Birmingham, AL, USA; 5Retina Consultants of Nashville, Nashville, TN, USA; 6Milos Eye Hospital, Belgrade, Serbia; 7Zagorskiego Eye Hospital, Krakow, PolandCorrespondence: Robert E MorrisRetina Specialists of Alabama, 2208 University Blvd, Ste. 101, Birmingham, AL 35233, USAEmail rmorris@retinanetwork.comPurpose: In this study, we report the treatment outcomes of complete and early vitrectomy for endophthalmitis (CEVE) after cataract surgery as the predominate initial treatment, accompanied by systemic antibiotics and retreatment of persistent or recurrent purulence (CEVE+).Patients and Methods: Clinical features and microbiological factors were retrospectively reviewed in 62 eyes of 62 patients who were treated for acute postcataract endophthalmitis (APCE) occurring within three weeks of cataract surgery at Retina Specialists of Alabama, between 2007 and 2017.Results: Visual acuity on presentation included light perception (LP) in 18 eyes (29%) and hand motion (HM) in 23 eyes (37%). Initial treatment was maximum possible vitrectomy in 48 eyes (77%) and tap-and-inject in 14 eyes (23%), with 38 eyes (61%) receiving two or more treatments. Cultures for the first intervention were positive in 49 eyes (79%) and virulent in 18 eyes (29%). At a median follow-up time of five months, final visual acuity was ≥ 20/40 in 49 eyes (79%), between 20/50 and 5/200 in seven eyes (11%), and < 5/200 in six eyes (10%). Virulence was the strongest predictor of poor visual outcome. Retinal detachment occurred in four eyes (6%), likely from necrotic retinal defects in each case.Conclusion: Complete and early vitrectomy is a safe and effective initial treatment for APCE. When accompanied by systemic antibiotics and retreatment (CEVE+) of recurrent media opacification, it improves recovery of 20/40 or better visual acuity by approximately 50% compared to a predominantly tap-and-inject treatment paradigm. We recommend CEVE for fundus-obscuring APCE (&sim; 75% of all cases) whenever the view is inadequate to rule out macular distress.Keywords: endophthalmitis, postcataract endophthalmitis, vitrectomy, tap and inject, TAP, VIT, EVS, APCE
format	article
author	Dib B Morris RE Oltmanns MH Sapp MR Glover JP Kuhn F
author_facet	Dib B Morris RE Oltmanns MH Sapp MR Glover JP Kuhn F
author_sort	Dib B
title	Complete and Early Vitrectomy for Endophthalmitis After Cataract Surgery: An Alternative Treatment Paradigm
title_short	Complete and Early Vitrectomy for Endophthalmitis After Cataract Surgery: An Alternative Treatment Paradigm
title_full	Complete and Early Vitrectomy for Endophthalmitis After Cataract Surgery: An Alternative Treatment Paradigm
title_fullStr	Complete and Early Vitrectomy for Endophthalmitis After Cataract Surgery: An Alternative Treatment Paradigm
title_full_unstemmed	Complete and Early Vitrectomy for Endophthalmitis After Cataract Surgery: An Alternative Treatment Paradigm
title_sort	complete and early vitrectomy for endophthalmitis after cataract surgery: an alternative treatment paradigm
publisher	Dove Medical Press
publishDate	2020
url	https://doaj.org/article/2dc28016459c46c6bbc56a0119f8eeb1
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Complete and Early Vitrectomy for Endophthalmitis After Cataract Surgery: An Alternative Treatment Paradigm

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