A major UK feasibility study has found that performing vitrectomy surgery much earlier in patients diagnosed with acute endophthalmitis could significantly improve visual outcomes compared with the traditional antibiotic-first approach.
Endophthalmitis is a rare but serious bacterial infection affecting the fluid and tissues inside the eye. While it occurs in only around one in every 1,000 to 2,000 patients undergoing invasive eye procedures, it remains one of the most devastating complications following eye surgery or injections and can result in severe sight loss or blindness.
Current treatment approaches across ophthalmology typically involve repeated intravitreal antibiotic injections during the early stages of the condition, with vitrectomy surgery reserved for cases where antibiotic treatment proves unsuccessful. Formal treatment guidelines are largely limited to patients who develop the condition following cataract surgery.
However, advances in vitreoretinal surgery over the last three decades have reopened the debate around earlier intervention. Modern small-gauge pars plana vitrectomy (PPV) techniques, including 23-, 25- and 27-gauge instruments, combined with wide-angle viewing systems and the routine use of silicone oil, have transformed the safety and effectiveness of the procedure.
The new 21-centre UK study is the first randomised controlled trial to investigate whether vitrectomy performed within 48 to 96 hours of diagnosis can improve outcomes for patients who develop endophthalmitis following any invasive eye procedure.
Researchers recruited 63 patients across the country and compared outcomes between those receiving early vitrectomy and those managed initially with antibiotics.
The findings were striking. After six months, patients treated with early vitrectomy achieved a median improvement of 40 letters in visual acuity (range 28-70 letters), compared with a median improvement of 13 letters (range 0-66 letters) among patients who initially received antibiotic treatment.
This represents more than three times the median visual improvement achieved through conventional care.
The benefits were not limited to improved sight. Patients who underwent early surgery also experienced faster recovery, helping to reduce both the physical discomfort associated with the infection and the anxiety linked to the risk of permanent sight loss.
Researchers also reported lower rates of non-serious adverse events in the early vitrectomy group (47% compared with 68%) and fewer cases of retinal detachment.
Importantly, both patients and surgeons found the treatment strategy acceptable, supporting the feasibility of a larger-scale trial.
While the study was designed as a Phase 2 feasibility trial and the sample size remains relatively small, investigators believe the results provide strong justification for a definitive Phase 3 randomised clinical trial.
Lead author Mahi Muqit, senior vitreoretinal consultant at Moorfields Eye Hospital and associate professor at the Institute of Ophthalmology at UCL, 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.”
If future research confirms these findings, early vitrectomy could become a new standard of care for managing acute endophthalmitis, offering improved visual outcomes and a faster route to recovery for patients facing one of ophthalmology’s most serious complications.
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