Outcomes of Postcataract Surgery Endophthalmitis Managed Without Microbial Cultures

Purpose: To evaluate outcomes of eyes with postcataract surgery endophthalmitis that were managed without microbial cultures.

Design: This retrospective, single-center comparative cohort study identified all cases of endophthalmitis after cataract surgery presenting between February 1, 2014, and November 1, 2022.

Subjects: All eyes presenting with presumed endophthalmitis requiring in-office treatment with intravitreal antibiotics and either a vitreous or aqueous tap were included.

Methods: Endophthalmitis cases were divided into the "culture group," if the vitreous or aqueous specimens were sent for microbiologic sampling, or into the "no culture group" if an aqueous or vitreous tap was performed but not sent for microbiologic sampling.

Main outcome measures: Best-corrected visual acuity (VA) 12 months after endophthalmitis presentation, incidence of retinal detachment, and need for subsequent procedures.

Results: Of the 232 endophthalmitis cases identified, 196 (85%) were in the "culture group" and 36 (15%) were in the "no culture group." At endophthalmitis presentation, eyes in the "culture group" had a mean (standard deviation [SD]) logarithm of the minimum angle of resolution (logMAR) VA (Snellen equivalent) of 2.14 (0.8) (20/2760) and mean (SD) logMAR VA in the "no culture group" was 1.93 (0.8) (20/1702) (P = 0.185). At 12-month follow-up, mean (SD) logMAR VA for the "culture group" was 0.80 (1.0) (20/126) and 0.41 (0.5) (20/50) in the "no culture group" (adjusted difference = 0.41, 95% confidence interval = -0.043 to 0.857, P = 0.076). Twenty of 196 (10%) eyes in the "culture group" developed secondary retinal detachments within 12 months of presentation compared with 0 in the "no culture group" (P = 0.045).

Conclusions: Eyes with endophthalmitis after cataract surgery managed without microbiologic cultures have similar visual outcomes to eyes managed with microbiologic cultures and may be less likely to develop secondary retinal detachments. This may be an acceptable strategy to manage endophthalmitis after cataract surgery when prompt access to a microbiologic facility is unavailable.

Financial disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.