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MICROBIOLOGIC SPECTRUM AND VISUAL OUTCOMES OF ACUTE-ONSET ENDOPHTHALMITIS UNDERGOING THERAPEUTIC PARS PLANA VITRECTOMY

Sridhar, Jayanth MD*,†; Yonekawa, Yoshihiro MD; Kuriyan, Ajay E. MD, MS; Joseph, Anthony MD§,¶; Thomas, Benjamin J. MD; Liang, Michelle C. MD§,¶; Rayess, Nadim MD*; Relhan, Nidhi MD; Wolfe, Jeremy D. MD; Shah, Chirag P. MD, MPH§; Witkin, Andre J. MD; Flynn, Harry W. Jr MD; Garg, Sunir J. MD*

doi: 10.1097/IAE.0000000000001358
Original Study

Purpose: To report the clinical presentation, microbiologic spectrum, and visual outcomes associated with acute-onset infectious endophthalmitis undergoing therapeutic pars plana vitrectomy.

Methods: Multicenter interventional retrospective noncomparative consecutive case series. Billing records were reviewed to identify all charts for patients undergoing pars plana vitrectomy within 14 days of diagnosis of acute-onset infectious endophthalmitis over a 4-year period at 5 large tertiary referral retina practices. Statistical analysis was performed to assess for factors associated with visual outcomes.

Results: Seventy patients were identified. The most common clinical setting was postcataract surgery (n = 20). Only 3 patients (4.3%) presented with 20/400 or better visual acuity (VA). Although most of the patients initially underwent vitreous tap and intravitreal antibiotic injection (n = 47, 67.1%), all patients eventually underwent pars plana vitrectomy within 14 days of presentation with 68.5% (48/70) of patients undergoing pars plana vitrectomy within 48 hours of presentation. Positive intraocular cultures were obtained in 56 patients (80%). The most common identified organism was Streptococcus sp (n = 19). Visual acuity at last follow-up was 20/400 or better in 19 patients (27.1%). Three patients underwent evisceration or enucleation (4.3%). Last recorded postoperative VA (mean LogMAR 1.99 ± 0.94, Snellen VA equivalent finger count) improved from presenting VA (mean LogMAR 2.37 ± 0.38, Snellen VA hand motions) (P ≤ 0.001). There was no statistically significant correlation between the underlying etiology or the timing of surgery with this VA outcome.

Conclusion: Although less than one-third of patients achieved 20/400 or better VA, this VA often improved significantly from presenting VA.

A multicenter retrospective review is presented of patients with acute-onset endophthalmitis undergoing therapeutic pars plana vitrectomy within 14 days of diagnosis. The most common identified organism was Streptococcus sp. While visual outcomes were generally poor, visual acuity often significantly improved from presentation to final visit.

*Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania;

Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, Florida;

Associated Retinal Consultants, William Beaumont Hospital, Oakland University School of Medicine, Royal Oak, Michigan;

§Ophthalmic Consultants of Boston, Boston, Massachusetts; and

New England Eye Center, Tufts University School of Medicine, Boston, Massachusetts.

Reprint requests: Sunir J. Garg, MD, Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA 19107; e-mail: sunirgarg@gmail.com

None of the authors has any financial/conflicting interests to disclose.

© 2017 by Ophthalmic Communications Society, Inc.