CHANGES IN THERAPEUTIC CONCEPTS OF ACUTE ENDOPHTALMITIS - REVIEW OF 92 CASES FROM 1980 TO 1993

Background The aim of our study was to develop possible criteria for t he choice of vitrectomy in the treatment of endophthalmitis. Materials and Methods Ninety-two patients with endophthalmitis who were seen be tween 1980 and 1993 were reviewed retrospectively and analysed regardi ng pathogenesis, bacteriological aetiology, as well as pre- and postop erative visual acuity comparing intravenous (i.v.) therapy alone to a combination with vitrectomy in 3 pretherapeutic visual acuity classes (class I < 0,02, class II 0.02 - < 0.1 and class III greater than or e qual to 0.1). Results Endophthalmitis most commonly occurred after cat aract extraction (39%). The best prognosis regarding final visual acui ty was found with Staph. epidermidis infection, the worst with Strepto cocci. Postoperative visual acuity in class I was significantly better after vitrectomy with 0.18 +/- 0.06 (Standard Error = SE) compared to i.v. therapy alone (0.06+/-0.03 SE) (p < 0.05 unpaired Student t-Test ). In class II, no such difference could be demonstrated. In class III , i.v. therapy yielded significantly better results (0.8+/-0.09 SE) th an vitrectomy (0.53+/-0.14 SE), however only by comparing the final - but not the best - obtained posttherapeutic visual acuity. Conclusion The more favourable results after vitrectomy in patients with very poo r pretherapeutic Vision suggest an important role of vitrectomy in the presence of extensive vitreous opacifications. The better outcome aft er i.v. therapy in patients with pretherapeutic vision greater than or equal to 0.1 could be influenced by the very short follow-up period w hich renders an evaluation of a potential loss of vision due to late c omplications after endophthalmitis impossible.