According to the Endophthalmitis Vitrectomy Study (EVS), which factor MOST strongly determined whether immediate pars plana vitrectomy or vitreous tap/biopsy was the appropriate treatment for acute post-cataract endophthalmitis?

• A Presence or absence of hypopyon
• B Time of onset (within 3 days versus after 7 days)
• C Causative organism identified on Gram stain
• D Initial presenting visual acuity — light perception (LP) or worse versus hand motions (HM) or better ✓

Explanation

The Endophthalmitis Vitrectomy Study (EVS) established that for post-cataract and post-secondary IOL implantation endophthalmitis: immediate vitrectomy was beneficial when initial VA was light perception (LP) ONLY — achieving significantly better visual outcomes compared to tap/biopsy in this group. When initial VA was hand movements (HM) or better, outcomes were equivalent between vitrectomy and tap/biopsy followed by intravitreal antibiotics. This remains the principal criterion guiding EVS-based management decisions.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.