In the endophthalmitis vitrectomy study (EVS), which management recommendation was established for post-cataract endophthalmitis presenting with vision worse than hand movements?

• A Immediate pars plana vitrectomy (PPV) with intravitreal antibiotics was superior to tap-inject alone for eyes presenting with vision < HM ✓
• B Immediate vitreous tap and injection (TVi) with intravitreal vancomycin and amikacin without vitrectomy
• C Systemic amikacin IV plus intravitreal vancomycin with deferred vitrectomy if no improvement at 48 hours
• D Enucleation within 24 hours to prevent sympathetic ophthalmia

Explanation

The Endophthalmitis Vitrectomy Study (EVS, 1995) enrolled post-cataract surgery endophthalmitis patients and compared immediate PPV vs. vitreous tap-inject (TVi). Key finding: for patients presenting with vision of light perception (LP) or worse, immediate PPV resulted in 3-fold better outcomes (20/40 final VA: 33% PPV vs. 11% TVi) and 50% lower rate of no light perception vision. For patients presenting with hand motion (HM) or better vision, there was no significant difference between PPV and TVi. Thus, EVS recommends: immediate PPV for LP vision; TVi is acceptable for HM or better vision. EVS also showed no benefit from systemic antibiotics (aminoglycosides/cephalosporins) in either group — systemic antibiotics are NOT standard for post-cataract endophthalmitis.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.