Early vitrectomy using silicone oil tamponade for endophthalmitis improves vision

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German and US investigators collaborated in a study of early vitrectomy to address endophthalmitis and reported that performing vitrectomy with silicone oil tamponade to manage postoperative endophthalmitis led to a significant improvement in visual acuity (VA) and had a low complication rate.¹ Constance Weber, MD, was the first author from the Department of Ophthalmology, University of Bonn, Bonn, Germany. The US researchers were from the John A. Moran Eye Center, Department of Ophthalmology & Visual Sciences, University of Utah, Salt Lake City.

The investigators explained that early vitrectomy performed to treat endophthalmitis that develops postoperatively may improve VA outcomes and silicone oil used as a tamponade has potential benefits for managing endophthalmitis.

In light of this, they conducted a study to evaluate the use of a silicone oil tamponade in the surgical management of endophthalmitis.

The investigators retrospectively reviewed all study patients who underwent pars plana vitrectomy with silicone oil tamponade for postsurgical endophthalmitis at the Department of Ophthalmology, University of Bonn between 2017 and 2021. They evaluated the preoperative data including the best-corrected visual acuity (BCVA) at the time of the diagnosis, clinical findings, and symptoms. At each follow-up examination, they evaluated the BCVA and any complications.

Results of analysis

Eighty-two study patients with a mean follow-up of 13.1 months (range, 1–58 months) were included.

The analysis showed that an intravitreal injection was the cause of the endophthalmitis in more than half of the patients (42 patients; 51.2%) and cataract surgery in 29 patients (35.4%). The mean time between the injection or the cataract surgery and onset of endophthalmitis was 8.8 days (range, 1–59 days). Staphylococcus epidermidis was the predominant pathogen in 16 patients (19.5%); no pathogen was identified in 47 patients (57.3%).

The initial BCVA was 2.1 logarithm of the minimum angle of resolution (logMAR), which improved significantly to 1.0 logMAR at 6 months and to 1.1 logMAR at 1 year following treatment (p < 0.001 for both comparisons). The researchers reported that the multivariate analysis found that a low BCVA at diagnosis (p = 0.041) significantly predicted poor VA outcomes.

Postoperative complications developed in 17 patients (20.1%). Five patients (6.1%) needed anterior chamber washout with repeated injections of antibiotics, 1 developed choroidal folds resulting from hypotony, 1 had corneal decompensation, 2 (2.4%) had persistent fibrin and udnerwent YAG laser, 3 (6.7%) developed a retinal detachment and underwent a repeated vitrectomy, 1 had a displaced intraocular lens, 2 (2.4%) had persistent corneal decompensation with endothelial cell loss and underwent a perforating keratoplasty, and 2 had recurrent intraocular inflammation after the silicone oil was removed.

A matched-pair analysis (n = 30, each group n = 15) compared use of silicone oil tamponade with balanced saline solution at the end of surgery. No significant differences in the VA outcome were seen (BCVA after 1 year, 1.17 logMAR in eyes with silicone oil and 0.90 logMAR in eyes with balanced saline; p = 0.684).

The investigators commented, “Our data show that early vitrectomy with silicone oil tamponade in the surgical management of postoperative endophthalmitis leads to an improvement in VA, and our results are comparable to other studies in which balance saline or air was as tamponade at the end of surgery. The choice of tamponade after performing a vitrectomy in patients with endophthalmitis should be decided individually at the discretion of the vitreoretinal surgeon.”

Reference:

1. Weber C, Stasik I, Hermann P, et al. Early vitrectomy with silicone oil tamponade in the management of postoperative endophthalmitis. J Clin Med. 2023;12:5097;https://doi.org/10.3390/jcm12155097