Comparison of Core Vitrectomy with Intravitreal Antibiotics Vs Early Complete Vitrectomy with Silicon Oil In Terms Of Final Best Corrected Visual Acuity in Post Cataract Surgery Endophthalmitis

Abstract

Background: Post-surgical endophthalmitis after cataract surgery is a vision threatening emergency which should be treated promptly with the help of surgery. Core vitrectomy using intravitreal antibiotics is favored, but early full vitrectomy with silicone oil tamponade has been suggested as a means to achieve better visual results.

Objective: To evaluate the effectiveness of intravitreal antibiotics versus early complete vitrectomy with silicone oil tamponade in terms of final best corrected visual acuity (BCVA) in patients with post-cataract surgery endophthalmitis.

Study design: The study was an interventional comparative study based on studying patients in the hospital.

Methods: The total number of patients with the diagnosis of acute endophthalmitis after cataract surgery was 60, who were split into 2 groups (n=30 in each group). Group A received core vitrectomy with intravitreal antibiotics (vancomycin and ceftazidime), and Group B received early complete pars plana vitrectomy with silicone oil tamponade as well as intravitreal antibiotics (vancomycin and ceftazidime). Demographic and clinical data were collected at the baseline. The main outcome was final BCVA 3-months post-operative (logMAR units). Data were analyzed with SPSS and p value less than 0.05 was considered as a statistically significant value.

Results:  The age, sex ratio and baseline BCVA did not differ between both groups (p > 0.05). The mean final BCVA for silicone oil group was significantly higher than that of core vitrectomy group (0.52 ± 0.38 logMAR vs 0.78 ± 0.42 logMAR, p = 0.01). The silicone oil group had a higher proportion of patients who achieved VA 6/18 or better (33.3% versus 16.7%). The silicone oil group had superior anatomical results and complication rates specifically with respect to resolution of infection and retinal separation—but these differences were not statistically significant.

Conclusion: In post-cataract surgery endophthalmitis, early complete vitrectomy with silicone oil tamponade is significantly better than core vitrectomy with intravitreal antibiotics in terms of functional visual outcomes. In certain severe cases silicone oil can have a potentially beneficial effect on visual rehabilitation.