Postoperative endophthalmitis treatment with antibiotics associated or not with pars plana vitrectomy: a randomized clinical trial

• DOI: 10.1186/s40942-025-00640-1
• Publication Date: 2025-02-18T05:08:31Z
• Authors: Vinicius Campos B...; Luis Filipe Nakayama; Nilva Simeren Bue...; Ivan Maynart Tavares; Mauro Silveira De...; Ana Luisa Hofling...; Maurício Maia
• Keywords: Endophthalmitis; Ophthalmology; Endophthalmitis vitrectomy study; Pars plana vitrectomy; RE1-994; Intravitreal antibiotic injection

Abstract Background Postoperative endophthalmitis (PSE) is a severe ocular complication that can lead to irreversible vision loss or even globe atrophy. The Endophthalmitis Vitrectomy Study (EVS) historically guided PSE management but increasingly questioned due advances in pars plana vitrectomy (PPV) techniques and its narrow focus on cataract surgery. This study aimed compare PPV followed by intravitreal antibiotic injection at the end of surgery (PPV + IVAIES) with alone (IVAI) managing PSE. Methods randomized clinical trial included 35 pseudophakic patients following extraction, anti-vascular endothelial growth factor (anti-VEGF) injections, glaucoma surgeries. Participants were receive either IVAIES (n = 12) IVAI 23). Best-corrected visual acuity (BCVA) was assessed baseline days 7, 30, 60, 90 post-intervention. Clinical worsening, defined as lack improvement progression symptoms within 48–72 h, retreatment protocols. Group A received repeat if required, while B underwent delayed IVAI. Statistical significance using repeated measures ANOVA logistic regression. Results Both groups showed significant BCVA (p < 0.001). resulted faster recovery, superior day 7 0.019) 30 0.041). Retreatment required 39.1% group not 0.015). Subgroup analysis indicated trend toward better early outcomes 0.029). Conclusions Early provides recovery reduces rates compared alone. Multicenter studies are warranted confirm these findings refine guidelines. Trial registration ClinicalTrials.gov identifier: NCT04192994.