Excellent outcomes of an intravitreal four drug regimen combined with single port limited pars plana vitrectomy or conventional three port pars plana vitrectomy for the treatment of acute post cataract surgery endophthalmitis

Session Details

Session Title: Inflammation and Pathology

Session Date/Time: Sunday 11/09/2016 | 14:30-16:00

Paper Time: 14:42

Venue: Hall C2

First Author: : A.Jhinja INDIA

Co Author(s): :    D. Singh   A. Sinha                 

Abstract Details

Purpose:

Anatomical and functional outcomes of an intravitreal four drug regimen (IFDR) combined with single port limited pars plana vitrectomy (SPLPPV) or conventional three port pars plana vitrectomy (TPPPV) for the treatment of acute post cataract surgery endophthalmitis (APCSE)

Setting:

Retrospective case series study at a referral eye hospital in western India over a four year period from 2011 to 2015

Methods:

Since 2011 we had started giving a cocktail of 4 drugs (vancomycin 1mg/0.1ml, voriconazole 100μg/0.1ml, pipericillin+tazobactam 225μg/0.1ml, and ceftazidime 2.25mg/0.1ml) in all fulminant cases of APCSE based on exciting results in some cases where TPPPV with conventional regimen of intravitreal vancomycin, ceftazidime with/without antifungals failed and pseudomonas or other virulent gram negative organisms sensitive to pipericillin+tazobactam grew on culture. The intravitreal injections were preceded by either conventional TPPPV (Light perception (PL) only, retinal detachment (RD)) or SPLPPV (Hazy cornea, better than PL-only vision). Cases with coexisting retinal detachment underwent silicon oil injecton (SOI). The follow-up data were analyzed

Results:

Of 35 eyes 34 were followed for minimum 6 months. 23 eyes underwent SPLPPV with IFDR. 11 eyes underwent TPPPV with IFDR and 1 eye with RD also got SOI. Hypopyon resolved in all one to 5 days posttreatment. Vitreous exudates resolved in all within 5 days to 2 weeks. All eyes had pretreatment vision of hand movement or worse. Vision improved in all eyes in SPLPPV group. All except one eyes of the TPPPV group had good visual gain. One patient aged 102 years developed recurrence one month later. He partially recovered vision after vitreous lavage and IFDR but lost to follow-up after 3 months. One eye with RD developed severe epiretinal membranes limiting visual gain

Conclusions:

The intravitreal four drug regimen for the treatment of endophthalmitis resulted in complete resolution of endophthalmitis in all cases. The worse final visual and anatomical out come in some cases was because of pretreatment severe retinal damage from endophthalmitis. This four drug regimen must be investigated further in a large multicenter trial for benefit of the masses.

Financial Disclosure:

NONE