When a storm is brewing inside of the vitreous, how do you get to the destination safely? Before the 1995 EVS study, there was no clear consensus on how to utilize vitrectomy and IV antibiotics for patients with post-op endophthalmitis. Therefore, the EVS study sought to define a treatment protocol for these scary cases. In the study, 420 patients with clinical evidence of endophthalmitis within 6 weeks after cataract surgery or secondary intraocular lens implantation were randomly assigned to four groups with combinations of pars plana vitrectomy PPV or no PPV, and treatment with or without systemic antibiotics.
Overall, EVS established an LP cutoff for routine PPV in post-op endophthalmitis. If a patient can see HM, you can wave them goodbye instead of taking them to the OR.
- Systemic antibiotics may not be necessary and increase cost, length of stay, and toxic side effects.
- Routine PPV is not necessary for patients with better than light perception (LP) vision at presentation.
- PPV is beneficial for patients presenting with LP or worse vision, leading to better visual outcomes and reduced adverse outcomes