Early Vitrectomy May Protect Vision in Post-Op Infections

TOPLINE:

Early pars plana vitrectomy (PPV) using modern surgical tools demonstrated promising outcomes in patients who developed endophthalmitis after cataract surgery or intravitreal injection. Most regained the clarity of vision they had before the infection, researchers found.

METHODOLOGY:

• Researchers conducted a single-center, retrospective observational study to examine how early PPV affected vision and rates of complications in patients who underwent treatment for endophthalmitis at University Hospital Zurich between 2006 and 2016.
• The analysis included 92 eyes of patients (mean age at procedure, 71.1 years; 46.7% men) who presented to the emergency department with endophthalmitis that developed after cataract surgery (n = 44), intravitreal injection (n = 12), trabeculectomy (n = 6), or other causes (n = 30).
• All patients underwent early vitrectomy, defined as surgery performed within 6 hours of presentation to the emergency department.
• Primary outcomes were visual acuity and intraocular pressure from before developing endophthalmitis to 12 months after vitrectomy; secondary outcomes were complications following the procedure.

TAKEAWAY:

• A year after vitrectomy, patients who had undergone cataract surgery or intravitreal injection demonstrated favorable visual outcomes, with visual acuity not statistically different from that before the infection (cataract surgery, P = .840 and intravitreal injection, P = .933); more than 50% of patients in both groups regained the level of visual acuity they had before developing endophthalmitis.
• In the group who underwent cataract surgery, 78.9% of eyes that perceived more than light and 40% of eyes that perceived only light at the time of diagnosis of endophthalmitis achieved 20/40 or better vision.
• Intraocular pressure was well controlled in all groups.
• All patients in the trabeculectomy group and 40%-50% of those who underwent cataract surgery or intravitreal injection had at least one complication that potentially threatened vision; most of these complications involved the macula or lens.

IN PRACTICE:

“The vitreoretinal surgical techniques have greatly improved with smaller gauge and better instruments, more sophisticated vitrectomy machines, and better illumination systems. These technical advances have made vitrectomy a much safer and more standardized operation,” the researchers of the study wrote. “The implication of this study is that early PPV should be considered for all cases of endophthalmitis, regardless of initial” visual acuity, they added.

SOURCE:

The study was led by Julian W. Sromicki, MD, of the Department of Ophthalmology at University Hospital and University of Zurich, Zurich, Switzerland. It was published online on July 9, 2025, in Ophthalmology and Therapy.

LIMITATIONS:

Because of the retrospective nature of this study, researchers could not conclude if PPV caused improvement in visual outcomes. The causes of postoperative complications were not systematically analyzed, making it unclear whether complications were due primarily to the surgical intervention or the severity of the underlying infection. The potential impact of variability due to surgeons was not considered, which may have introduced bias and affected the reliability and generalizability of the findings.

DISCLOSURES:

The authors declared having no relevant financial conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.