Purpose: To compare the visual outcomes after prompt pars plana vitrectomy (PPV) with tap biopsy and intravitreal antimicrobial injection (TAI) to treat post-injection and post-surgery endophthalmitis.
Methods: The Cochrane Central Register of Controlled Trials, OVID MEDLINE, and OVID Embase databases were searched for manuscripts published between January 2010 to November 2020. Two independent reviewers selected papers and extracted data. We analyzed data in RevMan 5.3 and assessed methodological quality using the Cochrane ROBINS-I tool. Mean improvement in visual outcome was compared between PPV and TAI as a relative risk of improving >= 2 lines, and a mean LogMAR difference in improvement.
Results: 15 retrospective case-series (1355 eyes), of which 739 (55%) received TAI and 616 (45%) PPV as initial treatment were included. The overall relative risk of improving 2 or more lines in PPV in comparison to TAI was 1.04 (95% CI 0.88-1.23; p=0.61; I2=0%) with a mean difference of 0.04 (95% CI -0.18-0.27; p=0.69; I2=0%). The results stayed robust when subgroup analysis based on causative procedure for endophthalmitis was performed.
Conclusions: TAI is non-inferior to PPV for the treatment of post-cataract operation, post-injection, and post-pars plana vitrectomy endophthalmitis.