Retinal Detachment in the Endophthalmitis Vitrectomy Study

OBJECTIVES: To assess the frequency of retinal detachment following postcataract endophthalmitis and to evaluate the results of management of these detachments. METHODS: Prospective data collected as part of the Endophthalmitis Vitrectomy Study were analyzed. The study was a randomized clinical trial testing the roles of vitrectomy and intravenous antibiotics in restoring vision in patients with endophthalmitis following cataract surgery. RESULTS: The incidence of retinal detachment was 8.3% after treatment of endophthalmitis, with no difference in frequency based on whether initial management was vitrectomy or tap biopsy. The frequency of detachment was higher with more virulent organisms, poor presenting visual acuity, an open posterior capsule at presentation, and in patients who required an early additional procedure in the management of their endophthalmitis. Retinal detachment resulted in a poor visual outcome, with only 27% of patients achieving 20/40 final visual acuity compared with 55% of patients who did not develop detachment. Patients who were able to undergo surgery for their detachment had a better result, with 38% achieving 20/40 final visual acuity. Anatomic success after surgical repair of detachment was achieved in 78% of patients. CONCLUSION: Retinal detachment is a poor prognostic indicator following endophthalmitis, but surgical repair can salvage excellent vision in a substantial number of patients.