Anatomical and visual outcome after pars plana vitrectomy in acute postcataract endophthalmitis

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Abstract

Purpose

To report visual and anatomical outcome of patients vitrectomized for acute post bacterial endophthalmitis

Methods

123 patients with acute postcataract endophthalmitis and consecutively treated by pars plana vitrectomy (PPV) were included in four academic hospitals (French Institutional Endophthalmitis Study (FRIENDS) group).

Results

At 6 month follow-up, 49 patients (40%) had a visual acuity (VA) greater than or equal to 20/40, and 83 patients (68%) had VA greater than or equal to 20/200. Baseline factors associated with final VA ≥20/40 were a younger age (Odds ratio, OR= 1.05 (1.05-1.09), p=0.006), presence of fundus visibility (OR=7 (1,4-34,6),p=0.007), and absence of cataract surgery complications (OR=15.3 (1.9-32), p=0.001), corneal edema (OR= 2.3 (1.1-4.9), p= 0.02), hypopion (OR= 2.6 (1.1-6.6), p=0.04), or of virulent bacteria (OR=3.1 (1.4-6.7), p=0.005). At the time of PPV, absence of vasculitis at the posterior pole at the time of PPV (OR= 7 (1.4-34.6), p=0.02) and a lower duration of PPV (OR=1.02 (1.01-1.04), p=0.02) were significantly associated with final VA ≥20/40. Risk factors of RD were diabetes (OR = 4.7 (1.4-15.4), p=0.01), and visualization of retinal vasculitis on the posterior pole (OR = 3.8 (1.1-13.9), p= 0.03) at the time of PPV.

Conclusion

PPV allowed to be beneficial in a majority of the patients. Baseline inflammatory signs and bacterial virulence are the main prognostic visual factors. RD remains the major complication but final anatomical and visual outcome is still poor, despite updated vitreoretinal techniques

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