Better visual outcome associated with early vitrectomy in the management of endophthalmitis.

Autor:	Welch S; Department of Ophthalmology, Auckland District Health Board, Auckland, New Zealand., Bhikoo R; Department of Ophthalmology, Auckland District Health Board, Auckland, New Zealand., Wang N; Department of Ophthalmology, Auckland District Health Board, Auckland, New Zealand., Siemerink MJ; Department of Ophthalmology, Auckland District Health Board, Auckland, New Zealand., Shew W; Department of Ophthalmology, Auckland District Health Board, Auckland, New Zealand., Polkinghorne PJ; Department of Ophthalmology, Auckland District Health Board, Auckland, New Zealand.; Department of Ophthalmology, University of Auckland, Auckland, New Zealand., Niederer RL; Department of Ophthalmology, Auckland District Health Board, Auckland, New Zealand dr_rachnz@yahoo.co.nz.; Department of Ophthalmology, University of Auckland, Auckland, New Zealand.
Jazyk:	angličtina
Zdroj:	The British journal of ophthalmology [Br J Ophthalmol] 2022 Aug; Vol. 106 (8), pp. 1145-1149. Date of Electronic Publication: 2021 Mar 12.
DOI:	10.1136/bjophthalmol-2020-316846
Abstrakt:	Aims: To examine the role of early vitrectomy in the management of endophthalmitis from all causes. Methods: Retrospective study of 290 consecutive subjects diagnosed with endophthalmitis at Auckland District Health Board between 1 January 2006 and 31 July 2019. Main outcome measure was visual acuity at 9-month follow-up and proportion of subjects with severe vision loss (≤20/200). Results: Median age at presentation was 70.4 years and 151 subjects (52.1%) were women. Cataract surgery was the most common cause of endophthalmitis in 92 subjects (31.7%) followed by intravitreal injection in 57 (19.7%), endogenous endophthalmitis in 48 subjects (16.6%), non-surgical trauma in 42 subjects (14.5%), glaucoma surgery in 24 subjects (8.3%), vitrectomy in 22 subjects (7.6%) and corneal in 5 subjects (1.7%). Culture was positive in 136 (46.9%) with gram-positive organisms most common (76.5%). Early vitrectomy was performed in 82 subjects (28.3%). Median visual acuity at 9 months was 20/100 (IQR 20/30 to light perception), and severe vision loss occurred in 100 (43.5%). Retinal detachment occurred in 35 eyes (12.1%) and 26 eyes were enucleated. On multivariate analysis, younger age, poor presenting visual acuity and culture-positive endophthalmitis were associated with worse outcomes, and early vitrectomy was associated with better outcomes. Conclusions: Early vitrectomy (within 24 hours) is associated with better visual outcomes at 9 months, while younger age, poor presenting visual acuity and culture-positive endophthalmitis are associated with poorer visual acuity outcomes. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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