Visual Outcomes of Early Intravitreal Antibiotics and Factors Affecting Presumed Acute Endophthalmitis Post Cataract Surgery in Tertiary Eye Hospital: An Observational Study

TL;DR

This study examines how early intravitreal antibiotics affect vision in patients with post-cataract surgery endophthalmitis, finding improved visual outcomes after treatment.

Contribution

The study provides new observational evidence on the effectiveness of early intravitreal antibiotics in treating post-cataract endophthalmitis.

Findings

Early intravitreal antibiotics improved visual acuity from 6/120 to 6/15 over 60 days.

No significant differences in outcomes were found based on age, gender, or surgical technique.

Most patients received only intravitreal antibiotics without additional vitrectomy.

Abstract

Acute pofl-cataract infectious endophthalmitis is a rare yet serious complicationthat can lead to significant intraocular inflammation and potential loss of vision following cataract surgery. Early diagnosis and prompt treatment are essential to prevent irreversible damage to photoreceptors. While the Early Vitrectomy Study (EVS) provided initial treatment guidelines, clinical approaches have since evolved.

In this observational, retrospective single-center study at Biratnagar Eye Hospital, we analyzed data from patients diagnosed with presumed endophthalmitis within six weeks of cataract surgery in 2023. All patients received intravitreal antibiotics (vancomycin and ceftazidime) and underwent tap biopsy for microbiological analysis. Data included demographics, clinical features, treatment (intravitreal antibiotics ± vitrectomy), and visual acuity (LogMAR) at baseline and 60 days. The data were recorded in Excel and analyzed using Statical Package for the Social Sciences version 29.0 (IBM Corp., Armonk, NY, USA).

The study found that 44 (87.70%) were between 40-80 years old, with males 28 (57.14%). Symptoms appeared primarily within the firfl two weeks pofl-surgery in 31 (62%) of cases. Phacoemulsification 24 (48%) and Small Incision Cataract Surgery 26 (52%) were represented in the patient population. Out of total patients,44 (88%) of the patients received only intravitreal antibiotics. A notable improvement was observed in visual acuity with mean Log MAR values decreasing from 1.395± 0.632 on Day 1 (Snellen equivalent 6/120) to 0.441±0.553 on Day 60 (Snellen equivalent 6/15). No notable variations in visual acuity was observed in age, gender, surgical technique (phacoemulsification vs. SICS), or adjunctive dexamethasone.

Findings suggefled that early therapeutic intervention with intravitreal antibiotics in acute pofloperative endophthalmitis may improve visual outcomes when evaluated at 60 days pofl-treatment.

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