Postoperative Bacterial Endophthalmitis: Tap/Inject versus Sutureless Vitrectomy

Purpose: To compare sutureless vitrectomy (VIT) versus vitreous tap/injection (TAP) in eyes with postoperative bacterial endophthalmitis.

Methods: Retrospective study of 126 consecutive eyes that underwent VIT (82) or TAP (44) between 2005 and 2015. All eyes were stratified into a group according to their pre and postoperative visual acuity. Group 1 included patients with visual acuity of 20/40 or better, group 2 had a visual acuity ranging from 20/50 to 20/100, group 3 had a visual acuity <20/100- 20/400, group 4 had a visual acuity of <20/400-CF, and group 5 had a visual acuity of HM-LP. Outcome measures were post intervention visual acuity (VA) and complications.

Results: Mean preop VA was 20/2000 in VIT and 20/1800 in TAP (p=0.30), while postop VA was 20/160 in VIT and 20/125 in TAP (p=0.18). Preoperative vision was HM or LP in 87/126 eyes. Among those with poor preoperative vision of <20/400, postoperative vision was significantly better in the VIT group when compared to the TAP group (p=0.05). In eyes with good preoperative vision (20/400 or better), the mean postoperative vision was not significantly different between the VIT or TAP group (p=0.94). Final vision in all eyes was 20/40 or better in 25%, 20/100 or better in 56%, and only 11% had vision of HM or worse. Twelve eyes (9.5%) developed retinal detachment (RD), all in the VIT group, with 11/12 presenting with poor preoperative vision.

Conclusion: VIT or TAP has a similar visual outcome in patients with postoperative bacterial endophthalmitis that present with 20/400 or better vision. Sutureless vitrectomy (VIT) was found to be more beneficial than TAP in patients with worse than 20/400 initial vision. RD is more likely in the VIT group primarily due to poor presenting visual acuity.

Keywords: Endophthalmitis, vitrectomy (VIT), tap and inject (TAP)