ACUTE-ONSET ENDOPHTHALMITIS AFTER CATARACT SURGERY Success of Initial Therapy, Visual Outcomes, and Related Factors

Purpose: To evaluate the success of initial treatment and the factors influencing the outcome in acute-onset endophthalmitis after cataract surgery. Methods: We retrospectively reviewed the medical records of all patients with acute postoperative endophthalmitis between 2000 and 2007. We performed pars plana vitrectomy (PPV) to all eyes with initial visual acuity of light perception. Eyes with visual acuity of hand motions or better underwent either intraocular antibiotic injection (IOAI) or PPV. Eyes that did not give a good clinical response to initial therapy within 60 hours underwent a second procedure. The main outcome measure was the rate of early reintervention after PPV and IOAI. Results: We evaluated 88 eyes of 88 patients. Thirty-seven patients underwent PPV and 51 patients underwent IOAI alone. Six of 37 (16.2%) patients required 1 or more procedures within 60 hours of the initial procedure in the PPV group. Twenty-eight of 51 eyes (54.9%) in the IOAI group underwent PPV within 60 hours. The rate of response to primary PPV was significantly higher than to primary IOAI (P < 0.001). Gram-negative organisms composed 35.1% of the isolates. Conclusion: Pars plana vitrectomy may be preferable to IOAI in postoperative endophthalmitis since the rate of early reintervention is lower with initial PPV. RETINA 29:606-612, 2009