Comparison Between Early Vitrectomy and Intravitreal Antibiotic Injection in Endophthalmitis Following Cataract Surgery

Purpose: To compare the clinical outcomes of early pars plana vitrectomy versus intravitreal antibiotic injection in patients who developed infectious endophthalmitis after cataract surgery.Methods: The medical records of patients diagnosed with infectious endophthalmitis following cataract surgery between 2006 and 2023, whose initial best-corrected visual acuity (BCVA) values were 0.48 to 2.3 in LogMAR units, were retrospectively reviewed. Final BCVA and the degree of visual improvement were compared between early vitrectomy and intravitreal antibiotic injection-only groups. Additionally, patients who underwent delayed vitrectomy within 3 days after the initial intravitreal antibiotic injection (delayed vitrectomy group) were separately analyzed and compared.Results: At 6 months post-treatment, the mean BCVA values were significantly better in the early vitrectomy group (0.37 ± 0.27) than in the injection group (1.02 ± 0.81) (<i>p</i> = 0.004); the early vitrectomy group also had greater visual improvement at both 1 week and 6 months after treatment (<i>p</i> = 0.004, <i>p</i> < 0.001). Compared to the delayed vitrectomy group, the early group demonstrated significantly greater visual improvement at both time points (<i>p</i> = 0.010, <i>p</i> = 0.001). The retreatment rate was higher in the injection group than in the early vitrectomy group.Conclusions: In patients who developed infectious endophthalmitis after cataract surgery and had an initial visual acuity between light perception or better and 20/60, early vitrectomy resulted in better visual outcomes compared to intravitreal antibiotic injection alone or delayed vitrectomy.