Do Treatment Patterns for Endophthalmitis after Cataract Surgery Follow the Endophthalmitis Vitrectomy Study Recommendations?: An Academy IRIS® Registry Analysis

Abstract

ObjectiveEvaluate whether treatment patterns for endophthalmitis after cataract surgery in American Academy of Ophthalmology IRIS® Registry (Intelligent Research in Sight) patients are in line with evidence-based guidelines established by the 1995 Endophthalmitis Vitrectomy Treatment Study (EVS), which showed that patients who present with light perception vision (LP) have better visual outcomes with immediate vitrectomy (VIT) compared with vitreous tap with antibiotic injection (TAP). DesignRetrospective cohort study SubjectsIRIS Registry patients undergoing cataract surgery between 2014 and 2022 (identified by CPT codes), presenting with endophthalmitis (identified by ICD 10 codes) within 42 days post-cataract surgery, and having a record of being treated with VIT or TAP on the same or one day following endophthalmitis diagnosis were identified. MethodsPotential covariates of age, sex, race, ethnicity, geographic region, insurance status, and visual acuity on the day of endophthalmitis diagnosis were evaluated using multivariable logistic regression. Main Outcome MeasureTreatment with VIT or TAP ResultsOf the 2425 patients who met the inclusion criteria, 14% (345) underwent VIT and 86% (2080) underwent TAP. 80% of patients (1946) presented with endophthalmitis within 14 days from cataract surgery (median = 6 days). Notably, 66% (173/263) of the patients presenting with LP vision underwent TAP instead of VIT. In a multivariable logistic regression model, receiving VIT instead of TAP was positively associated with poor vision at endophthalmitis presentation (LP – OR, 5.3 [CI: 2.9-10.5]; Counting Fingers, Hand Motion – OR 1.8 [CI: 1.0-3.6]) vs. [20/20-20/40] vision; Asian vs. White race (OR, 2.6 [CI: 1.2-5.1]); Hispanic vs. Non-Hispanic ethnicity (OR, 1.9 [CI, 1.0-3.2]); living in the West (OR, 1.5 [CI, 1.1-2.2]) and Midwest (OR- 1.4 [CI, 1.0-2.0]) (vs. South), but not with age, sex, and insurance coverage (P>0.05). ConclusionsIn the IRIS Registry, treatment patterns for post-cataract surgery endophthalmitis did not match evidence-based recommendations of the EVS, a randomized controlled clinical trial. More work is needed to evaluate whether the current treatment patterns are optimal for patients with post-cataract surgery endophthalmitis.