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 vitreo...

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Bibliographic Details
Published in:Canadian journal of ophthalmology 2002-12, Vol.37 (7), p.395-398
Main Authors: Siddiqui, Farhan, Crippen, Craig, Hutnik, Cindy M.L.
Format: Article
Language:English
Subjects:
Anti-Bacterial Agents - therapeutic use
Biological and medical sciences
Biopsy
Canada
Cataract Extraction - adverse effects
cataract surgery
complications
endophthalmitis
Endophthalmitis - microbiology
Endophthalmitis - surgery
Endophthalmitis Vitrectomy Study
Eye Infections, Bacterial - microbiology
Eye Infections, Bacterial - surgery
Health Surveys
Humans
Medical sciences
Postoperative Complications - microbiology
Postoperative Complications - surgery
Practice Guidelines as Topic - standards
Practice Patterns, Physicians' - statistics & numerical data
Randomized Controlled Trials as Topic
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surgery of the eye and orbit
treatment
Visual Acuity
Vitrectomy
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Summary: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, II (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 I (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 I (3.3%) would use intravenous antibiotic therapy. Fourteen respondents (46.7%) would use intraocular steroid therapy. Interpretation: Most of the Canadian vitreoretinal surgeons who responded to this survey do not follow the recommendations of the EVS. Contexte: L'Étude du traitement de l'endophtalmie par vitrectomie (EVS) consistait en une enquête clinique, multicentrique et randomisée, qui avait pour objet de guider le traitement de l'endophtalmie bactérienne postopératoire. Selon l'hypothèse, les chirurgiens ne suivent
ISSN:0008-4182
1715-3360
DOI:10.1016/S0008-4182(02)80041-2