A feasibility study published in Communications Medicine found that early vitrectomy may provide greater visual benefit for patients with acute endophthalmitis than the current antibiotic-first approach.
Acute endophthalmitis is a bacterial infection affecting the fluid and tissue inside the eye. While rare, it is caused by a complication from any form of eye surgery or eye injection, and can lead to sight loss and blindness. Treatment guidelines only exist for cataract treatment, and the conventional approach across ophthalmology has been to repeat intravitreal antibiotic injections during the early phase of the condition, then conduct a vitrectomy if this has not proved effective.
The 21-center national UK study of 63 patients, led by researchers at Moorfields Eye Hospital NHS Foundation Trust, is the first randomized controlled trial to evaluate the potential benefits of performing vitrectomy at an early stage, within 48 to 96 hours of diagnosis of endophthalmitis following an invasive eye procedure.
The study enrolled adults with postoperative endophthalmitis following ocular surgery, procedure, or intravitreal injection who had symptomatic visual loss and best corrected visual acuity worse than 35 ETDRS letters.
At 6 months, patients undergoing early vitrectomy had a median improvement of 40 ETDRS letters (28 to 70) compared with a median improvement of 13 ETDRS letters (0 to 66) among patients initially treated with repeated intravitreal antibiotic injections.
Although the between-group difference did not reach statistical significance because the trial was designed as a feasibility study rather than an efficacy trial, investigators reported a clinically meaningful 24-letter adjusted difference favoring early vitrectomy.
Early vitrectomy also showed lower rates of non-serious adverse events (47% vs 68%) and retinal detachment. Retinal detachment occurred in 2 of 30 patients (6.7%) undergoing early vitrectomy compared with 8 of 33 patients (24%) receiving standard care.
The study demonstrated the feasibility of the approach and its acceptability to patients and surgeons. Overall, 79% of eligible patients agreed to randomization, demonstrating that a larger multicenter trial is practical.
“This important new study shows the potential short-term and long-term potential benefits to patients given an early vitrectomy if they contract endophthalmitis after their eye procedure," said lead author Mahi Muqit, senior vitreoretinal consultant at Moorfields Eye Hospital and associate professor at the Institute of Ophthalmology at UCL. "As using this intervention at diagnosis shows clear potential to improve clinical outcomes, we now intend to take this forward to a definitive phase 3 randomized clinical trial that can definitively answer this question.”