Treatment of endophthalmitis after cataract extraction.

BACKGROUND: A series of 34 patients was prospectively treated for postoperative endophthalmitis according to a specific protocol. The data are from the pilot study performed before initiation of the Endophthalmitis Vitrectomy Study (EVS). METHODS: Patients with bacterial endophthalmitis that developed within 6 weeks of cataract extraction received intravitreal amikacin and vancomycin, subconjunctival and topical antimicrobials and corticosteroids, and systemic corticosteroids. All patients had diagnostic samples removed from the aqueous and vitreous, with randomized assignment to immediate vitrectomy versus vitreous tap and treatment with or without intravenous antibiotics. Outcome was evaluated 3 and 9 months after treatment. RESULTS: At the 9-month visit, visual acuity was 20/50 or better in 49% of all eyes, 20/200 or better in 79%, and 5/200 or better in 91%. Media clarity was such that a "20/40 or better view" of the retina was present in 71% of patients at 3 months and in 97% at 9 months. CONCLUSION: This is one of the largest series of patients with postoperative endophthalmitis treated and evaluated under a prospective protocol and without selection bias. Each of the options used in this study to treat postoperative endophthalmitis may result in good visual results.

Augmentation laser for proliferative diabetic retinopathy that fails to respond to initial panretinal photocoagulation.

PURPOSE: A study was performed to determine if diabetic subjects who fail to respond to initial panretinal photocoagulation with regression of retinopathy risk factors do better with supplemental panretinal photocoagulation. METHODS: Thirty-five patients with 3 or more retinopathy risk factors who failed to respond to panretinal photocoagulation with regression to less than 3 retinopathy risk factors by 3 weeks after initial panretinal photocoagulation were prospectively randomized to augmentation laser panretinal photocoagulation (MORE) or to no additional treatment (NOMORE). RESULTS: Six months after initial treatment, the MORE group (n = 16) had regressed a mean of -0.94 retinopathy risk factors (with 95% confidence interval [CI] -1.60 to -0.26), compared with -0.21 retinopathy risk factors (95% CI -0.69 to 0.27) in the NOMORE (n = 19) group (P = 0.055). However, by 1 year, there was no statistically significant difference in the amount of regression of retinopathy risk factors with a mean decrease of -1.12 (95% CI -2.0 to -0.24) versus -1.05 retinopathy risk factors (95% CI -1.80 to -0.28) in the 2 groups, respectively. Similarly, for visual acuity, there was no difference in outcome. For all study patients, the persistence of three or more retinopathy risk factors was associated with a poorer visual result than if there was regression to less than three retinopathy risk factors. CONCLUSION: This study shows that although augmentation panretinal photocoagulation achieved faster regression of retinopathy risk factors, by 1 year, there was no difference in either mean regression of retinopathy risk factors or visual acuity between eyes treated or not treated with augmentation panretinal photocoagulation. In addition, the study shows that the persistence of 3 or more retinopathy risk factors 1 year after treatment was associated with a poorer visual result. Because sample size limited the power of the study to find small differences between groups, and because in proliferative diabetic retinopathy small differences could be important clinically, the authors do not recommend changes in current clinical practice.