Comparison of Re-vitrectomy Rates in TAP and INJECT versus Pars Plana Vitrectomy for Acute Endophthalmitis: A Retrospective Comparative Study

บทคัดย่อ

Background: Acute endophthalmitis is a severe complication of ocular surgery requiring prompt treatment to prevent vision loss. The optimal initial treatment—vitreous tapping with intravitreal injection (TAP) versus pars plana vitrectomy (PPV)—remains debated. Advances in vitrectomy techniques challenge conclusions from the Endophthalmitis Vitrectomy Study (EVS), prompting this study to compare re-vitrectomy rates and outcomes between TAP and PPV.
Methods: This retrospective study analyzed 34 patients diagnosed with acute endophthalmitis at a tertiary care center. Patients were divided into TAP (Group 1, n = 10) and PPV (Group 2, n = 24) groups. Demographic data, clinical presentations, microbial culture results, and outcomes—including visual acuity (VA) improvement and re-vitrectomy rates—were compared using statistical analyses. A subgroup analysis focused on patients with presenting VA ≥ hand motion.
Results: Group 1 (TAP) had a significantly higher re-vitrectomy rate (50% vs. 16.7%, p = 0.044) despite comparable VA improvement between groups (50% vs. 45.8%, p = 0.618). In the subgroup with VA ≥ hand motion, re-vitrectomy rates were higher in Group 1 (44.4% vs. 9.5%, p = 0.028), while VA improvement was similar (62.5% vs. 52.4%, p = 0.62). Positive microbial cultures were exclusive to Group 2 (29.1%).
Conclusion: TAP and PPV yield comparable VA improvement, but PPV significantly reduces the need for re-vitrectomy, highlighting the advantages of modern surgical techniques. Further research is needed to refine treatment protocols.