Endophthalmitis management study. Report #1. Protocol

Abstract

To date, the Endophthalmitis Vitrectomy Study (EVS) has remained the hallmark of evidence-based management of acute bacterial endophthalmitis after cataract surgery with an intraocular lens. In the last quarter-century since its publication, several studies have reported that the microbiological spectrum of endophthalmitis is not the same across the world; there is emerging antibiotic resistance of gram-negative microorganisms to the EVS recommended antibiotics; there are newer molecules that could cross the blood-retinal barrier; the advances in vitreous surgery have become safer than before, and there are newer methods of microbiological evaluation. One of the often-mentioned drawbacks of the EVS was not recruiting grossly infected eyes with poor visibility of the iris and vitreous. Keeping these factors in mind, a new prospective multi-centered randomized study, the Endophthalmitis Management Study (EMS), is designed. The EMS will recruit all post-cataract surgery endophthalmitis patients irrespective of severity (including suspected fungal infection); the EMS will use quantifiable inflammatory score instead of the presenting vision to allocate for surgery, randomize the eyes to two different combinations of intravitreal antibiotics and use the newer microbiological diagnostic techniques. We believe the EMS findings will complement the EVS recommendations.

Keywords: Cataract surgery; endophthalmitis; inflammatory score; intravitreal antibiotic; vitrectomy.

Figure 1

EMS randomization. Cefta- ceftazidime; TAP- vitreous tap (aspiration); Vanco- vancomycin; VIT- vitrectomy

Figure 2

EMS treatment protocol. IOP- intraocular pressure; SL- Slitlamp; VA- visual acuity. Day 3 (shaded boxes)- Repeat intervention, when considered

Figure 3

Fundus photograph scheme (Right eye). 1- Disc nasally; 2- Temporal to macula; 3- Inferior to macula; 4- Superior to macula. (mirror image for the left eye)