Intravitreal Antibiotics versus Early Vitrectomy Plus Intravitreal Antibiotics for Postinjection Endophthalmitis: An IRIS® (Intelligent Research in Sight Registry) Analysis

Abstract

Purpose: To determine if intravitreal injection of antibiotics alone versus early pars plana vitrectomy (PPV) plus injection of intravitreal antibiotics predicted better or worse visual outcomes for patients with endophthalmitis after anti-VEGF injections.

Design: Retrospective cohort study.

Participants: Patients developing endophthalmitis after receiving an intravitreal anti-VEGF injection from the American Academy of Ophthalmology IRIS® (Intelligent Research in Sight) Registry between 2016 and 2020.

Methods: Inclusion criteria were endophthalmitis diagnosis within 1 to 28 days after anti-VEGF injection and a recorded visual acuity (VA) at baseline, on the day of diagnosis, and posttreatment. Patients in the Injection Only group underwent intravitreal injection of antibiotics alone and in the Early Vitrectomy group received PPV with intravitreal antibiotics or intravitreal injection followed by PPV within 2 days of diagnosis. Patients were excluded if they had cataract surgery during the study, intravitreal steroids before endophthalmitis, or intermediate/posterior uveitis or cystoid macular edema. The study created a 1:1 matched cohort using Mahalanobis distance matching, accounting for the differences in VA at baseline and diagnosis.

Main outcome measures: Posttreatment logarithm of the minimum angle of resolution (logMAR) VA.

Results: A total of 1044 patients diagnosed with postinjection endophthalmitis met the inclusion and exclusion criteria. In the unmatched cohort, there were 935 patients in the Injection Only and 109 in the Early Vitrectomy group. In 1:1 matched cohort, 218 patients (109 in each group) were included; the median logMAR VAs were 0.32 (20/40-20/50) at baseline, 0.88 (∼20/150) at diagnosis, and 0.57 (20/70-20/80) posttreatment. There were no statistically significant differences in the visual outcomes between the 2 matched treatment groups (b = 0.05; P = 0.23); including the subgroup of patients with VA worse than 1.0 logMAR (b = 0.05; P = 0.452).

Conclusions: There was no significant difference in final VA outcomes between patients receiving Injection Only and those treated with Early Vitrectomy for postinjection endophthalmitis. The findings support the use of either treatment strategy.

Financial disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Keywords: Anti-VEGF therapy; Endophthalmitis; IRIS® Registry; Pars plana vitrectomy.