Early surgery for bacterial eye infection offers hope to patients
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Early vitrectomy surgery for acute endophthalmitis, a rare eye condition, may potentially benefit patients' vision more than the current antibiotic-first approach, according to a study led by researchers at University College London (UCL) and Moorfields Eye Hospital.
The results of the phase 2 clinical trial testing feasibility have been published in Communications Medicine.
Endophthalmitis is a bacterial infection affecting the fluid and tissue inside the eye. It is a rare condition, affecting one in 1,000 to 2,000 patients, but is a devastating complication of any form of eye surgery or eye injection and can lead to sight loss and blindness. Treatment guidelines exist only for cataract treatment, and the conventional approach across ophthalmology has been to repeat antibiotic injections into the eye during the early phase of the condition, then conduct a vitrectomy (surgery to remove the gel-like vitreous humor from inside the eye) if this has not proven effective.
Thirty years ago, research indicated the potential benefits of immediate vitrectomy for patients developing endophthalmitis after cataract surgery, but this is seldom carried out. Since then, advances in surgical approaches—including the development of small-gauge pars plana vitrectomy (PPV), wide-angle viewing systems and the routine use of silicone oil—have significantly evolved the procedure.
Testing surgery earlier
This national U.K. study of 63 patients treated at 21 hospitals is the first randomized controlled trial to evaluate the potential benefits of carrying out vitrectomy at an early stage, within 48–96 hours of diagnosis of endophthalmitis following any type of invasive eye procedure.
After six months, patients receiving this treatment had a median improvement of 40 additional letters they could read in a test using a sight chart with five letters per row, compared with those who had an initial regimen of antibiotics for up to six months, which led to a median 13-letter increase in vision. The median improvement for the new approach was therefore more than three times that of the conventional treatment.
Importantly, these improvements came earlier for patients, bringing relief and recovery from what can be a painful condition, as well as removing the psychological shadow of potential sight loss sooner. At the six-month cutoff, the study shows that these patients may achieve greater improvements in visual acuity, which, if these improvements endure, could further increase the social benefit.
Early vitrectomy also showed lower rates of nonserious adverse events (47% versus 68%) and retinal detachment.
A larger trial now beckons
The study team validated the feasibility of the approach and its acceptability to patients and surgeons.
These promising results are based on a sample of 63 patients and therefore have relatively low levels of statistical significance, but they point to the merits of conducting a larger phase 3 clinical trial.
Lead author Mahi Muqit, associate professor at the UCL Institute of Ophthalmology and senior vitreoretinal consultant at Moorfields Eye Hospital, said, "This important new study shows the potential short- and long-term benefits to patients given an early vitrectomy if they contract endophthalmitis after their eye procedure. As using this intervention at diagnosis shows clear potential to improve clinical outcomes, we now intend to take this forward to a definitive phase 3 randomized clinical trial that can definitively answer this question."
Publication details
Mahiul MK Muqit et al, Early vitrectomy and intravitreal antibiotics for post-operative exogenous endophthalmitis (EVIAN): a randomised control trial of feasibility, Communications Medicine (2026). DOI: 10.1038/s43856-026-01664-w
Journal information: Communications Medicine
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Ophthalmology Provided by University College London Who's behind this story?
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