Endophthalmitis after Cataract Surgery: Changes in Management Based on Microbiologic Cultures

Written by: Philip P. Storey, MD

Feb 2021

Samir N. Patel, MD, Philip P. Storey, MD, MPH, Hannah Levin, BS, Maitri Pancholy, MD, Anthony Obeid, MD, MPH, Turner D. Wibbelsman, BS, Brandon Kuley, BA, Allen C. Ho, MD, Jason Hsu, MD, Sunir J. Garg, MD, James F. Vander, MD, James P. Dunn, MD. Ophthalmology Retina 2021; 5:16-21.

Endophthalmitis following cataract surgery can have devastating consequences. The Endophthalmitis Vitrectomy Study (EVS) remains one of the few evidence-based studies guiding management of acute infection following cataract surgery. While the EVS provides recommendations for pars plana vitrectomy for eyes with light perception or worse visual acuity (VA), management guidelines after initial treatment remain unclear.

In this study, the authors evaluate the role of microbiologic culture data in guiding management of endophthalmitis. The single-center, retrospective study includes 111 eyes treated for endophthalmitis after cataract surgery, 51% of which were culture-positive. After initial treatment of endophthalmitis, a change in clinical management after microbiologic culture occurred in 9 of 111 eyes (8%) including 11% of culture-positive eyes compared to 6% for culture-negative eyes (p=0.49). Changes in management were based on declining vision, worsening clinic examination, and retinal detachment; no additional interventions were initiated based on the positive-culture result. At final follow-up, mean VA for culture-positive eyes was ~20/250 while mean VA for culture-negative eyes was ~20/80 (p=0.03).

Vitreous taps may result in significant complications. In the EVS, retinal detachment occurred in 11% of eyes following vitreous tap. In the current study, 17% of patients developed retinal detachment or tears following vitreous tap. While culture data may help prognosticate final visual outcomes, microbiologic data may not impact clinical management. Retina specialists may consider anterior chamber tap for microbiologic sampling as a potential alternative to vitreous taps. When treating endophthalmitis following cataract surgery, rapid administration of intravitreal antibiotics should be administered irrespective of available microbiological facilities.