Do we heed the endophthalmitis vitrectomy study in Canada?
BACKGROUND
The Endophthalmitis Vitrectomy Study (EVS) was a multicentre randomized clinical trial designed to guide the management of postoperative bacterial endophthalmitis. There is speculation that many physicians do not follow its recommendations, despite its intent. We surveyed Canadian vitreoretinal surgeons to determine whether surgeons are adopting the EVS recommendations in their management of bacterial endophthalmitis after cataract surgery.


METHODS
A survey was sent to 98 vitreoretinal surgeons across Canada who manage postoperative endophthalmitis following cataract surgery. The survey explored the management of patients presenting with a hypopyon or suspected endophthalmitis, or both, early (up to 2 weeks) after cataract surgery. For purposes of comparison with the EVS, the questions were divided into presenting visual acuity categories.


RESULTS
Of the 98 surgeons 30 (30.6%) responded to the survey. The preferred treatment for patients presenting with no light perception visual acuity was pars plana vitrectomy (23 respondents [76.7%]); 7 respondents (23.3%) preferred vitreous tap/biopsy. All but one of the respondents stated that they prefer pars plana vitrectomy for patients presenting with light perception vision; the remaining physician preferred either pars plana vitrectomy or vitreous tap/biopsy. For patients with hand motions visual acuity, 17 respondents (56.7%) would perform pars plana vitrectomy, 11 (36.7%) would perform vitreous tap/biopsy, and 2 (6.7%) would perform either procedure. Most of the respondents (20 [66.7%]) would perform vitreous tap/biopsy for patients with visual acuity of counting fingers, whereas 9 (30.0%) would perform pars plana vitrectomy, and 1 (3.3%) would perform either procedure. All the respondents indicated that they would use intraocular antibiotic therapy for initial treatment, 29 (96.7%) would use topical antibiotic therapy, 17 (56.7%) would inject antibiotics subconjunctivally, and 1 (3.3%) would use intravenous antibiotic therapy. Fourteen respondents (46.7%) would use intraocular steroid therapy.


CONCLUSIONS
Most of the Canadian vitreoretinal surgeons who responded to this survey do not follow the recommendations of the EVS.
Siddiqui
Farhan
F
Department of Family Medicine, University of Manitoba, Winnipeg, Man.
Crippen
Craig
C
Hutnik
Cindy M L
CM
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001706:Biopsy; D002170:Canada; D002387:Cataract Extraction / Q000009:adverse effects; D009877:Endophthalmitis / Q000382:microbiology / Q000601:surgery*; D015818:Eye Infections, Bacterial / Q000382:microbiology / Q000601:surgery*; D006306:Health Surveys; D006801:Humans; D011183:Postoperative Complications / Q000382:microbiology / Q000601:surgery*; D017410:Practice Guidelines as Topic / Q000592:standards*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D016032:Randomized Controlled Trials as Topic; D014792:Visual Acuity; D014821:Vitrectomy
D000900:Anti-Bacterial Agents