Prognostic factors associated with the visual outcome after vitrectomy for endophthalmitis

Background: Functional results following vitrectomy with intraocular and systemic antibiotic treatment for endophthalmitis are influenced by numerous factors. Methods: A retrospective study of 65 cases of endophthalmitis treated between October 1988 and May 1994 at the Department of Ophthalmology, University of Cologne, Germany was conducted. All eyes underwent pars plana vitrectomy and intraocular and systemic antibiotic treatment. Results: Vision of 20/400 or better could be obtained in 66% of eyes following extracapsular cataract extraction and intraocular lens implantation (ECCE + IOL), in 62% after severe eye injury, in 36% of eyes after intraocular surgery for other reasons than cataract extraction with lens implantation and in 33% of patients with endogenous endophthalmitis. Vision of 20/50 or better could be achieved in 41% of eyes following ECCE + IOL and additional systemic steroid treatment. In 22% of cases primary silicone endotamponade was performed; 57% of these eyes obtained visual acuity of 20/400 or better. Fifteen patients (23%) suffered diabetes mellitus; 20/400 vision or better could be achieved in 73% of these eyes. Visual acuity of hand movements or better before vitrectomy was associated with 20/400 vision or better in 69% of cases, whereas ambulatory vision could be attained in only 33% of patients with visual acuity of worse than hand movements at the initial presentation. Visual acuity of less than 20/400 was found in all eyes with haemolytic streptococcal infections. Conclusion: Prompt treatment of endophthalmitis is crucial. Additional treatment using systemic steroids and, if necessary, silicone oil can improve the functional outcome in some cases.