Ferenc Kuhn, MD, PhD (Birmingham, AL), Giampaolo Gini, MD (Prato, Italy)

PURPOSE:

Following recommendations in the Endophthalmitis Vitrectomy Study (EVS), vitrectomy for postoperative endophthalmitis is performed today only if visual acuity drops to light perception. The authors evaluated their results achieved by performing complete and early vitrectomy for these eyes.

METHODS:

The authors treat their patients with postoperative endophthalmitis very differently. If there is excellent red reflex or some retinal details are visible, intravitreal antibiotics and corticosteroids are injected, and the patient is closely monitored for 24 hours. If the condition does not improve or if there is no red reflex/retinal visibility, complete vitrectomy is performed, regardless of the visual acuity. Every effort is made to remove the posterior hyaloid and clean the macular area.

RESULTS:

In a consecutive series of 47 patients, we achieved 0.5 or greater vision in 91% of eyes with no case of retinal detachment,  phthisis, or enucleation. These results are significantly better than those seen in the EVS.

CONCLUSION:

The authors advocate complete and early vitrectomy for eyes with postoperative endophthalmitis. Complications of both the purulent process and its therapy are reduced if the surgical intervention is early and aimed at total removal of the infectious and inflammatory debris. Both the anatomical and functional results have been found to be superior to those achieved with conservative therapy.