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Acute postoperative endophthalmitis after cataract operation: result of early vitrectomy within 24 hours of presentation

Eye volume 37, pages 2344–2350 (2023)Cite this article

Subjects

Abstract

Objectives

To evaluate result of early pars plana vitrectomy (PPV) within 24 hours of presentation for acute postoperative endophthalmitis after cataract operation, and to determine factors that predict visual outcome.

Methods

Consecutive patients who developed acute postoperative endophthalmitis within 6 weeks after cataract operation were reviewed. Patients were divided into two groups for analysis: (1) those receiving PPV within 24 hours of presentation (early PPV group), and (2) those receiving initial intravitreal antibiotics only without PPV within 24 hours of presentation (IVA group).

Results

Out of 41,411 cataract operations, 22 eyes developed acute postoperative endophthalmitis. Presenting VA was hand-movement or worse in 72.7%. The most common organisms were Staphylococcus (40.9%), Streptococcus (13.6%) and Enterococcus (13.6%). 22.7% of eyes had good final VA ≥ 20/30 and 27.3% had poor final VA < 20/400. Early PPV group had significantly lower rate of requiring additional treatments to control infection (25% versus 80%, P = 0.030), higher rate of retinal detachment (25% versus 0%, P = 0.221) and similar final logMAR VA (1.08 ± 1.08 versus 0.80 ± 0.80, P = 0.489) compared to IVA. Multivariate linear regression analysis showed that worse final VA was significantly associated with Streptococcus (ß = 1.92, P = 0.007) and retinal detachment (ß = 1.72, P = 0.005) but not with early PPV (P = 0.225).

Conclusion

Early PPV was superior to initial intravitreal antibiotics alone as it required fewer additional treatments to control infection. Visual outcome was similar between early PPV and initial intravitreal antibiotics alone despite high number of poor presenting VA of light-perception in early PPV group. Streptococcal infection and retinal detachment were major poor prognostic factors for vision.

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Data availability

Data are available on reasonable request. Data are available from the corresponding author.

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Authors and Affiliations

  1. Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China

    Lawrence Pui Leung Iu, Ho Yan Chan, Gabriel Ka Hin Li, Mary Ho, Andrew Chun Yue Mak, Posey Po Yin Wong, Ka Wai Kam & Alvin Lerrmann Young

  2. Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China

    Lawrence Pui Leung Iu, Ho Yan Chan, Gabriel Ka Hin Li, Mary Ho, Andrew Chun Yue Mak, Posey Po Yin Wong, Ka Wai Kam, Li Jia Chen, Marten Brelen & Alvin Lerrmann Young

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  1. Lawrence Pui Leung Iu
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Contributions

LPLI had substantial contribution to the conception and design of the work; acquisition and analysis of data; drafting of the paper. HYC, GKHL, ACYM and PPYW had substantial contribution to the acquisition and analysis of data; critical review and revision of the paper. MH, KWK, LJC, MB and ALY had substantial contribution to the conception and design of the work; acquisition of data; critical review and revision of the paper.

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Correspondence to Lawrence Pui Leung Iu.

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Iu, L.P.L., Chan, H.Y., Li, G.K.H. et al. Acute postoperative endophthalmitis after cataract operation: result of early vitrectomy within 24 hours of presentation. Eye 37, 2344–2350 (2023). https://doi.org/10.1038/s41433-022-02347-1

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