Search

This paper reports the results of an exploratory analysis among patients in the Endophthalmitis Vitrectomy Study to determine if there was a different response to treatment in diabetes and whether the signs and symptoms of endophthalmitis differ between diabetic and nondiabetic patients. Patients in this multicenter clinical trial were followed for 9 months after random assignment to either vitrectomy or tap/biopsy. Outcome measures included visual acuity assessed in standardized fashion. Fifty-eight of 420 study patients were diabetic. Diabetics presented with slightly worse vision and ocular media. Only 39% of diabetics compared with 55% of nondiabetics achieved 20/40 final vision. Both diabetic and nondiabetic patients who presented with vision of only light perception (LP) had better visual results with immediate vitrectomy. For those who presented with better than LP vision, diabetics achieved 20/40 more often with vitrectomy (57%) than with tap/biopsy (40%), but non diabetics did equally well with vitrectomy or tap/biopsy. In the diabetic group, small numbers did not allow adequate statistical power to test treatment difference. A new clinical trial is needed to determine if in fact there is a difference in response to treatment among diabetic and nondiabetic patients who present with better than LP vision.

Purpose This report describes the presenting clinical ophthalmic features and historical findings in patients with a clinical diagnosis of endophthalmitis after cataract extraction or secondary lens implant surgery screened for enrollment in the Endophthalmitis Vitrectomy Study (EVS). Design Clinic-based, cross-sectional study. Participants Eight hundred fifty-four patients suspected to have endophthalmitis after cataract extraction or secondary lens implantation. Methods As part of the screening process for the study, an eye examination, a medical history, and demographic data were recorded in standardized form for all patients with endophthalmitis after cataract extraction or secondary lens implant surgery referred to the clinical centers, regardless of whether the patient met entry criteria. Main outcome measures Demographics, presenting signs, and symptoms. Results The median age of individuals presenting with suspected bacterial endophthalmitis was 75 years (range, 9–100 years). Most of those screened (57.7%) were women. Seventy-nine percent of patients sought treatment within 6 weeks of surgery. Blurred vision, conjunctival injection, pain, and lid swelling were the predominant presenting symptoms in order of prevalence. Ocular pain and hypopyon, widely regarded as diagnostic of endophthalmitis, were each absent in 25% of patients. The median hypopyon height, when present, was 1.5 mm. Conclusions The classic presentation of postoperative endophthalmitis includes reduced vision, conjunctival hyperemia, pain, hypopyon, and lid swelling within days after cataract surgery or secondary lens implantation. These were the prominent clinical findings in the EVS as well. Because pain and hypopyon, although common, were not always present, clinicians must be vigilant in postsurgical monitoring of patients.

Objectives To determine whether there was a different response to vitrectomy and tap/biopsy with or without systemic antibiotic treatment in the Endophthalmitis Vitrectomy Study and whether the signs and symptoms of endophthalmitis differ between diabetic and nondiabetic patients. Design A multicenter clinical trial in which patients with acute post–cataract extraction endophthalmitis were randomly assigned in a 2 × 2 factorial design to vitrectomy or tap/biopsy, in each case with or without intravenous antibiotics, and followed up for 9 months. Outcome measures included visual acuity assessed in standardized fashion. Results Fifty-eight of 420 study patients had diabetes. Diabetic patients had slightly worse vision and ocular media at the baseline assessment. Only 39% of diabetic patients compared with 55% of nondiabetic patients achieved 20/40 final vision. Both diabetic and nondiabetic patients with initial light perception(LP)-only vision had better visual results with immediate vitrectomy. For those with better than LP baseline vision, patients with diabetes achieved visual acuity of 20/40 more often with vitrectomy (57%) than with tap/biopsy(40%), but this difference was not statistically significant. Patients without diabetes did equally well with vitrectomy or tap/biopsy. Conclusions For patients with better than LP vision, tap/biopsy is appropriate for those without diabetes. A clinical trial of a sufficient number of diabetic patients with better than LP vision is necessary to determine the best management for this group. At present, initial vitrectomy or tap/biopsy are reasonable approaches for diabetic patients with better than LP vision.