Early vitrectomy surgery treatment for a rare eye condition, acute endophthalmitis, can be potentially more beneficial to patients’ vision compared with the current antibiotic-first approach, finds a study led by University College London (UCL) and Moorfields Eye Hospital researchers.
The results of the phase 2 clinical trial to test feasibility have been published in Communications Medicine.
Endophthalmitis
Endophthalmitis is a bacterial infection affecting the fluid and tissue inside the eye. It is a rare condition (one in 1,000 to 2,000 patients) but is a devastating complication from any form of eye surgery or eye injection, and can lead to sight loss and blindness.
Treatment guidelines only exist for cataract treatment, and the conventional approach across ophthalmology has been to repeat antibiotic injections into the eye during the early phase of the condition, then conduct a vitrectomy (surgery to remove the gel-like vitreous humour from inside the eye) if this has not proven effective.
Thirty years ago, research indicated the potential benefits of immediate vitrectomy for patients developing endophthalmitis after cataract surgery, but this is seldom carried out. Since then, advances in surgical approaches – including the development of small gauge pars plana vitrectomy (PPV), wide-angle viewing systems and the routine use of silicone oil – have led to a significant evolution for the procedure.
Clinical trial
This national UK study of 63 patients treated at 21 hospitals is the first randomised control trial to evaluate the potential benefits of carrying out the vitrectomy at an early stage, within 48-96 hours of diagnosis of endophthalmitis following any type of invasive eye procedures. Early vitrectomy showed lower rates of non-serious adverse events (47% vs 68%) and retinal detachment.
After six months, patients receiving this treatment had a median improvement of 40 additional letters they could read (in a test using a sight chart with five letters per row), compared with those having an initial regime of up to six months of antibiotics (which led to a median 13 letters increase in vision). The median improvement for the new approach therefore shows over three times the median sight improvement of the conventional treatment.
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Importantly, these improvements came earlier for patients too, bringing relief and recovery from what can be a painful condition as well as removing the psychological shadow of potential sight loss from them sooner. At the six-month cut-off period, this study shows these patients can potentially achieve greater improvements in acuity which, if this endures, further increases the social benefit.
Lead author Mr Mahi Muqit, associate professor at the UCL Institute of Ophthalmology and senior vitreoretinal consultant at Moorfields Eye Hospital, said: “This important new study shows the potential short-term and long-term potential benefits to patients given an early vitrectomy if they contract endophthalmitis after their eye procedure. As using this intervention at diagnosis shows clear potential to improve clinical outcomes, we now intend to take this forward to a definitive phase 3 randomised clinical trial that can definitively answer this question.”
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