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Bernard H. Doft, MD; Stephen R. Wisniewski, PhD; Sheryl F. Kelsey, PhD; Shirley Groer Fitzgerald, PhD; and the Endophthalmitis Vitrectomy Study Group

Arch Ophthalmol. 2001;119:650-656.

Objectives  To determine whether there was a different response to vitrectomy and tap/biopsy with or without systemic antibiotic treatment in the Endophthalmitis Vitrectomy Study and whether the signs and symptoms of endophthalmitis differ between diabetic and nondiabetic patients.

Design  A multicenter clinical trial in which patients with acute post–cataract extraction endophthalmitis were randomly assigned in a 2 x 2 factorial design to vitrectomy or tap/biopsy, in each case with or without intravenous antibiotics, and followed up for 9 months. Outcome measures included visual acuity assessed in standardized fashion.

Results  Fifty-eight of 420 study patients had diabetes. Diabetic patients had slightly worse vision and ocular media at the baseline assessment. Only 39% of diabetic patients compared with 55% of nondiabetic patients achieved 20/40 final vision. Both diabetic and nondiabetic patients with initial light perception (LP)-only vision had better visual results with immediate vitrectomy. For those with better than LP baseline vision, patients with diabetes achieved visual acuity of 20/40 more often with vitrectomy (57%) than with tap/biopsy (40%), but this difference was not statistically significant. Patients without diabetes did equally well with vitrectomy or tap/biopsy.

Conclusions  For patients with better than LP vision, tap/biopsy is appropriate for those without diabetes. A clinical trial of a sufficient number of diabetic patients with better than LP vision is necessary to determine the best management for this group. At present, initial vitrectomy or tap/biopsy are reasonable approaches for diabetic patients with better than LP vision.

From Retina Vitreous Consultants (Dr Doft) and the University of Pittsburgh, Graduate School of Public Health (Drs Wisniewski, Kelsey, and Fitzgerald), Pittsburgh, Pa. A list of the members of the Endophthalmitis Vitrectomy Study Group was published previously (Arch Ophthalmol. 1995;113:1493-1495).

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