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Therapie der postoperativen Endophthalmitis

Operieren oder nur injizieren?

Treatment of postoperative endophthalmitis

Operate or only inject?

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Zusammenfassung

Hintergrund

Die postoperative Endophthalmitis gehört zu den gefürchtetsten Komplikationen nach einem intraokularen Eingriff. Eine rasche Diagnose sowie Therapieeinleitung sind entscheidend für die Visusprognose, die zudem von den ursächlichen Keimen abhängt. Trotz neuer Erkenntnisse über Prävention und Epidemiologie der Endophthalmitis beruht ein Großteil der Evidenz für die Therapie auf einer einzigen Studie, der Early Vitrectomy Study (EVS), die am Anfang der 1990er-Jahre durchgeführt wurde. In der EVS zeigte sich, dass eine Vitrektomie mit intravitrealer Antibiose erst ab einem Visus von Lichtschein oder schlechter einer alleinigen intravitrealen Antibiose überlegen ist. Systemische Antibiotika hatten keinen positiven Effekt auf den Endvisus. Seitdem haben sich die chirurgischen Techniken weiterentwickelt und auch die medikamentösen Optionen erweitert. Zudem untersuchte die EVS nur Endophthalmitiden nach Kataraktchirurgie und kann somit streng genommen keine Behandlungsempfehlung für Endophthalmitiden anderer Genese abgeben.

Ziel

In dieser Übersicht soll auf die aktuelle Evidenz für die Therapie der postoperativen Endophthalmitis stratifiziert nach der jeweiligen Genese eingegangen werden.

Schlussfolgerungen

Viele Erkenntnisse aus der EVS scheinen bis heute ihre Gültigkeit bewahrt zu haben. Angesichts der Verfeinerung der chirurgischen Techniken, neuer Behandlungsmöglichkeiten, insbesondere der heutzutage zahlreich durchgeführten intravitrealen Medikamenteneingaben und teilweise neuen Antibiotika, wäre es wünschenswert, wenn neue kontrollierte Studien zur Behandlung der Endophthalmitis durchgeführt werden würden.

Abstract

Background

Postoperative endophthalmitis is among the most feared complications encountered after intraocular surgery. A prompt diagnosis and initiation of treatment are crucial for the visual prognosis, which also depends on the causative microorganism. Despite advances in prevention and the availability of more epidemiological data, most of the evidence for treatment dates back to a single study, the early vitrectomy study (EVS) carried out in the early 1990s. The EVS showed that vitrectomy with intravitreal antibiotics was superior to intravitreal antibiotics alone, only when visual acuity was light perception or below. The addition of systemic antibiotics did not have any benefits. Over the last 30 years, however, surgical techniques have continued to evolve and the medicinal options have also been expanded. Moreover, the EVS examined only endophthalmitis after cataract surgery and strictly speaking the results cannot be transferred to endophthalmitis from other causes.

Objective

This review discusses the current evidence for the different treatment modalities of the most important types of postoperative endophthalmitis.

Conclusion

The EVS provided important guidelines for the initial management of endophthalmitis and these guidelines remain relevant to this day; however, in view of the refinement of surgical techniques, novel treatment options, especially the nowadays continuously growing number of intravitreal injections and even some new antibiotics, it would be desirable if new controlled trials addressing the treatment of endophthalmitis would be performed.

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  1. Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Hamburg-Eppendorf (UKE), Gebäude W40, Martinistr. 52, 20246, Hamburg, Deutschland

    L. Mautone, C. Skevas & M. S. Spitzer

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Correspondence to C. Skevas.

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Mautone, L., Skevas, C. & Spitzer, M.S. Therapie der postoperativen Endophthalmitis. Ophthalmologe 118, 219–229 (2021). https://doi.org/10.1007/s00347-021-01320-9

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