Pedro Neves, Si­lvia Dinis, Pedro Gomes, Mario Ornelas, Margarida Santos, David Martins, Portugal

Introduction & Objectives: 
Post-operative endophthalmitis is a sight-threatening complication that may happen after any invasive procedure. The EVS study prospectively evaluated outcomes after either a “tap-and-inject” conservative management vs proceeding with a vitrectomy. However, this study is today over 20 years old, and vitrectomy has changed dramatically. Today, this procedure is safer, quicker, the vitreous can be cleared almost completely and entry ports are smaller. Also, dealing with many cases of endophthalmitis with a successful surgery earlier may be able to save vision in more aggressive cases, as well as resulting in less surgical complexity. Many authors defend either a modified EVS protocol or injecting intravitreal antibiotics and doing a vitrectomy in the first 24h. Also, repeated injections may result in increased retinal toxicity. The authors review current evidence and studies on this subject and present illustrative cases.

CASE 1 – a case of a patient submitted to a trabeculectomy and 5 months later presenting with an endophthalmitis. The patient was injected with Intravitreal antibiotics and subjected to a vitrectomy after 36h. Final visual acuity was no light perception.

CASE 2 – a case of a patient treated for diabetic macular edema that developed an endophthalmitis 3 days after an antiVEGF injection. The patient was injected with antibiotics and, after a repeat injection, was submitted to a vitrectomy after 48h. Final visual acuity was 2/10 (BCVA was previously 8/10).

Case 3 – another case of a patient with an endopthalmitis 1 week after injection with an antiVEGF for an AMD. She was also treated with antibiotics but instead operated after less than 24h, with a PPV and silicone oil tamponade. Final visual acuity was equal to the BCVA before the infection.

The role of vitrectomy was already supported by the original EVS study. In modern age retinal surgery, when surgeons all over the globe perform this surgery for many less-urgent diagnoses with increasingly better outcomes, should we really avoid or delay this procedure in endophthalmitis?

Contact Details:

Pedro Neves
Setubal Hospital Center
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