PURPOSE:To evaluate long-term visual and anatomical outcomes and complications following combined pars plana vitrectomy (PPV) and scleral fixation of intraocular lenses (IOLs) using Gore-Tex (polytetrafluoroethylene, PTFE) suture. With an average follow up of 10 years, this study provides longitudinal data on this increasingly common technique. METHODS:Single-center retrospective review of patients who underwent combined PPV and PTFE scleral sutured IOL fixation between 2012 and 2016 with a minimum follow-up of 7 years. Main outcome measures were best-corrected visual acuity (BCVA) at 3 months, 1 year, 5 years, and final follow-up, as well as the incidence and type of postoperative complications. RESULTS:A total of 55 eyes of 55 patients with a mean follow-up of 10 years (range, 7-12) were included. The mean age was 65 years (range, 32-91), and 71% were male. Mean BCVA improved from 20/300 (1.17 ± 0.92 logMAR) preoperatively to 20/70 (0.55 ± 0.72 logMAR) at 3 months postoperatively (p<0.001). Statistically significant visual improvement was maintained at 1 year (p=0.01), 5 years (p=0.03), and final follow up (p=0.02). Postoperative complications included cystoid macular edema in 6 eyes (11%), persistent corneal edema in 2 eyes (3.6%) that required corneal transplantation, visually significant IOL tilt in 2 eyes (3.6%), and suture exposure in 2 eyes (3.6%). There were no cases of endophthalmitis or suture breakage. CONCLUSION:Scleral fixation of IOLs using PTFE suture demonstrates significant visual improvement and a low rate of suture-related complications and reoperations over a 10-year follow-up period.

PURPOSE:To identify predictors of visual acuity (VA) after surgical management of hemorrhagic choroidal detachment (HCD) and assess whether surgical timing or drainage technique affects anatomic outcomes and postoperative rhegmatogenous retinal detachment (RRD). METHODS:Retrospective cohort of surgically managed HCD eyes. Timing was categorized as 0-6, 7-14, or ≥15 days from diagnosis. Primary outcome was postoperative month-6 (POM6) best available VA (logMAR) analyzed with multivariable linear regression. Secondary outcomes included HCD resolution and postoperative RRD. RESULTS:Sixty-seven eyes were included (mean age 74.8 ± 12.1 years; 44.8% female). Median time to surgery was 8-days (IQR, 3-14). Mean VA improved from 2.57 ± 0.34 logMAR (Snellen 20/8000) to 2.07 ± 0.79 logMAR (Snellen 20/2400) at POM6 (p<0.001). Using 7-14 days as reference, 0-6-day surgery independently predicted worse POM6 VA (p=0.008), whereas ≥15 days surgery did not. Worse baseline VA, appositional choroidal detachments, and trauma were also independently associated with poorer POM6 VA (p<0.05). Time to HCD resolution did not differ by timing or drainage technique; however, all five repeat drainages occurred in the 0-6-day group. Postoperative RRD occurred in 20 eyes (29.9%) and was independently associated with traumatic etiology. CONCLUSION:Early surgery was associated with worse 6-month visual outcomes compared with surgery at 7-14 days. Neither drainage technique nor surgical timing influenced anatomic resolution or postoperative RRD risk. These findings support delayed intervention until clot liquefaction when appropriate and identify trauma-associated HCD as a higher-risk subgroup.

Purpose: To investigate the incidence, characteristics, and outcomes of ocular toxoplasmosis-associated rhegmatogenous or tractional retinal detachment (RD). Methods: This was a single-center, interventional retrospective case series of consecutive patients diagnosed with ocular toxoplasmosis who subsequently developed rhegmatogenous RD (RRD) or tractional RD (TRD) between January 2013 and October 2022. Patients who were followed for at least 3 postoperative months were included. The location of the retinochoroidal scar, anatomy of the RD, surgical techniques used for repair, and anatomic and visual outcomes were analyzed. Results: Of 422 patients diagnosed with ocular toxoplasmosis, RRD or TRD developed in 36 patients (8.5%). Inclusion criteria were met in 20 eyes of 19 patients. The mean age at RD diagnosis was 47 years, and the mean follow-up was 3.6 years. Most ocular toxoplasmosis-associated RD were rhegmatogenous (75% [n = 15 eyes]), and half of the eyes had active retinochoroiditis at the time of presentation (50% [n = 10]). At final follow-up, median visual acuity (VA) had improved from counting fingers to about 20/80, and single-surgery anatomic success was achieved in 15 of 17 operated eyes (88%), with final reattachment achieved in 100% without silicone oil. Active retinochoroiditis at the time of RD diagnosis was associated with worse final VA after adjustment for confounding variables (P = .005). Conclusions: RRD or TRD occurred in 8.5% of patients with ocular toxoplasmosis. Surgery produces favorable anatomic results, but visual outcomes remain guarded, especially in eyes with active retinochoroiditis.

Purpose: To investigate the real-world incidence and management of ocular hypertension (OHT) following intravitreal 0.18mg fluocinolone acetonide implant (FAi, Yutiq) for non-infectious uveitis affecting the posterior segment (NIU-PS). Methods: Retrospective review of eyes treated with 0.18 mg FAi (2019–2025) with ≥1 month follow-up. Primary outcome was OHT (IOP >24 mmHg). Secondary outcomes included IOP ≥30 mmHg, >12 mmHg IOP increase from baseline, and OHT treatment. Results: A total of 275 FAi-treated eyes (178 patients, mean age: 62.87 years) were included. Patients received an average of 1.05 FAi (range:1–2), with mean follow-up of 20.59 ± 0.72 months. Mean baseline IOP was 14.30 ± 3.90 mmHg. Glaucoma and OHT were present in 28.4% and 32.4% of eyes, respectively and 38.5% were on IOP-lowering therapy. Supplemental corticosteroid injections were required in 31.3%. The OHT rate after FAi was 10.5%. Elevated IOP ≥30 mmHg occurred in 5.82%. IOP >12 mmHg from baseline occurred in 7.3%. Among OHT eyes, 41.4% resolved with observation, 44.8% required topical therapy (mean 1.78 agents), and 10.3% required incisional surgery. Higher baseline IOP (adjusted OR 1.41 per 1 mmHg increase, 95% CI:1.19–1.67) and baseline IOP-lowering medication use (OR 8.56, 95% CI:2.61–28.11) were the strongest predictors of rise in IOP. Conclusion: FAi for the treatment of NIU-PS was associated with low rates of OHT, reinforcing its safety. Eyes with higher baseline IOP and those on prior IOP-lowering medications had a substantially increased risk of OHT, highlighting the need for closer IOP monitoring in this subgroup.

Purpose: To determine whether a topical rho-kinase inhibitor used in eyes with primary rhegmatogenous retinal detachment (RRD) at high risk for proliferative vitreoretinopathy (PVR) reduces the rate of recurrent RD due to grade C or worse PVR. Methods: This randomized, double-masked, placebo-controlled trial (ClinicalTrials.gov: NCT05660447) included patients with primary RRD undergoing pars plana vitrectomy (PPV), with or without scleral buckling, who had 1 to 3 PVR risk factors: 3 or more breaks, 2 or more quadrants of RD, RD for longer than 3 weeks, vitreous hemorrhage, or choroidal detachment. Participants were randomized to netarsudil 0.02% or artificial tears, administered once daily for 8 weeks starting on postoperative day 1. The primary outcome was the rate of recurrent RD due to grade C PVR at 6 months. Results: A total of 79 patients were randomized (40 to netarsudil, 39 to placebo). After excluding dropouts and those lost to follow-up, 38 netarsudil and 34 placebo participants were analyzed. There was no significant difference in baseline high-risk features for PVR between the netarsudil and placebo arms. Eight eyes (21.1%) in the netarsudil arm vs 6 eyes (17.6%) in the placebo arm developed redetachment ( P = .77), with 4 vs 6 of the redetachments due to PVR (10.5% vs 17.6%; P = .5). At 6 months, epiretinal membrane was found in 55.2% of eyes in the netarsudil group and in 63.6% in the placebo group ( P > .99). Median logMAR (Snellen equivalent) visual acuity in the netarsudil vs placebo arm was 1.24 (20/350) vs 1.35 (20/450) at baseline ( P = .87), 0.7 (20/100) vs 0.48 (20/60) at month 3 ( P = .27), and 0.48 (20/60) vs 0.54 (20/70) at month 6 ( P = .91). Conclusions: Treatment of eyes with primary RRD at high risk for PVR with netarsudil 0.02% once daily for 8 weeks after PPV with or without scleral buckling did not appear to affect PVR redetachment or visual outcomes compared with placebo.

Objective:To describe the impact of social determinants of health (SDOH) on visual acuity (VA) at presentation among patients with retinal vein occlusion (RVO). Design:A retrospective single-center cohort study. Subjects:All patients with RVO (central and branch retinal vein occlusion [CRVO and BRVO]) who received their first intravitreal anti-VEGF injection between January 2015 and March 2025 at a single center. Methods:Sociodemographic factors including age, gender, race, and ethnicity were recorded. Social deprivation index (SDI) scores, a proxy for SDOH were determined using zip codes. An aggregate SDOH score was calculated and divided into quintiles, with quintile 5 (Q5) representing the highest SDOH burden. Information on hypertension and smoking status were also collected. Data on best available VA at presentation measurements were collected and were categorized as mild (20/40 or better), moderate (20/50 to 20/100), and severe vision loss (20/200 or worse). Main Outcome Measures:Factors affecting degree of vision loss at presentation. Results:A total of 9698 patients with RVO were included. Of these, 57% (n = 5490/9698) had a BRVO, and 43% (n = 4208/9698) had a CRVO. The proportion of patients with mild, moderate, and severe vision loss was 25% (n = 2425/9698), 41.8% (n = 4049/9698), and 33.1% (n = 3206/9698), respectively. On multivariable analysis, increasing SDI quintiles (higher SDOH burden) were associated with worse presenting baseline VA in patients with RVO (odds ratio [OR] 1.32, 95% confidence interval [CI]: 1.13-1.54; P < 0.001) for patients in the fifth quintile versus those in the first quintile. Odds of severe vision loss at initial RVO presentation were also greater among older patients (OR 1.03, 95% CI: 1.02-1.03; P < 0.001), Hispanics (OR 1.62, 95% CI: 1.22-2.14; P = 0.001) versus non-Hispanics, and Black (OR 1.34, 95% CI: 1.17-1.34; P < 0.001) and Asian (OR 1.30, 95% CI: 1.02-1.67; P = 0.04) patients compared to White patients. Former smokers (OR 1.41, 95% CI: 1.17-1.70; P < 0.001) and never smokers (OR 1.39, 95% CI: 1.17-1.66; P < 0.001) were more likely to have mild vision loss at initial RVO presentation compared to active smokers. Conclusions:Our study reveals associations between adverse SDOH and presenting VA among patients with RVO. Evaluating and intervening on effects of adverse SDOH may be a means to improve outcomes of patients with RVO. Financial Disclosures:Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

PURPOSE:Letrozole is a non-steroidal aromatase inhibitor commonly used for the treatment of postmenopausal estrogen receptor-positive breast cancer. We report a novel case of bilateral panuveitis associated with letrozole therapy. METHODS:Retrospective chart review. RESULTS:A 39-year-old female with a history of breast cancer presented with bilateral anterior chamber and vitreous inflammation, perivenular sheathing, retinal hemorrhages, and a focal area of retinal whitening in the left eye six weeks after starting letrozole therapy. Extensive infectious and systemic inflammatory work-up was negative. With letrozole cessation and corticosteroid therapy, the inflammation resolved, and the visual acuity improved to 20/20 bilaterally. DISCUSSION AND CONCLUSION:Letrozole-associated panuveitis has not previously been reported. This case highlights the importance of detailed medication history as well as the need for interdisciplinary collaboration when managing drug-induced uveitis. Early recognition and appropriate therapy can result in favorable visual outcomes.

Purpose:To report efficacy of intravitreal pegcetacoplan treatment over 36 months in eyes with subfoveal geographic atrophy (GA). Patients and Methods:The GALE (NCT04770545) open-label extension trial adds 12 months of results to the 24-month Phase 3 OAKS (NCT03525613) and DERBY (NCT03525600) trials, representing up to 36 months of continuous pegcetacoplan treatment. They included a heterogeneous population of eyes with subfoveal GA (63%). Pegcetacoplan-treated eyes enrolling in GALE continued at the same interval of pegcetacoplan monthly (PM) or every other month (PEOM). Patients' eyes in sham monthly or every-other-month arms crossed over to receive pegcetacoplan in GALE at the same interval (sham crossover). Consequently, projected sham, calculated from prior 24-month GA growth rate of sham-observed eyes in OAKS and DERBY averaged across four 6-month segments, was the comparator for the first 12 months of GALE (months 24-36). This analysis reports results of eyes with subfoveal GA at baseline. Results:In eyes with subfoveal GA, 84% had best corrected visual acuity (BCVA) ≥20/200 and 38% had BCVA ≥20/63 at OAKS and DERBY baseline. Pegcetacoplan reduced subfoveal GA growth rate by 21% (p<0.0001) with PM and 19% (p=0.0001) with PEOM over 36 months. Increasing efficacy over time was noted between months 24 and 36; 31% reduction in subfoveal GA growth rate with PM and 25% reduction with PEOM (both p<0.0001) compared with projected sham. Microperimetry demonstrated significant reduction in formation of absolute scotomas with PM at 24 months (-2.5 number of scotomas formed; 95% confidence interval [CI]: -4.5, -0.4; p=0.0205) and 36 months (-4.0 number of scotomas formed; 95% CI: -6.8, -1.2; p=0.0050), compared to sham crossover in subfoveal GA. Safety profile in GALE was consistent with OAKS and DERBY. Conclusion:Long-term efficacy of pegcetacoplan in slowing GA progression was demonstrated over 36 months in eyes with subfoveal GA.

PURPOSE:To describe the demographics, clinical characteristics, treatment patterns, and outcomes of pediatric patients with noninfectious posterior and panuveitis at a single center. METHODS:Retrospective cohort study of all eyes with posterior and panuveitis between June 2015 and June 2025 that were identified using ICD codes. Charts were reviewed for demographics, clinical characteristics, disease evolution, sequelae, and treatment. Eyes with less than 3 months of follow-up were excluded. RESULTS:Between 2015 and 2025, a total of 12 004 patients (16,810 eyes) were seen for any uveitis diagnosis. Of them, 281 children (449 eyes) were referred for a diagnosis of non-infectious uveitis and 106 eyes of 69 patients met inclusion criteria. Bilateral disease occurred in 50.7% of patients. The leading diagnosis was idiopathic uveitis (51.9% of eyes), with a mean follow-up of 42 months. Nearly all eyes experienced at least one inflammatory flare (mean 1.1 per eye). Topical corticosteroids were most used (60.9% of treated eyes). Ocular sequelae were nearly universal (98.1%), and the proportion of patients with vision 20/200 or worse remained stable from baseline to follow-up (39.1% vs 40.6%). Linear mixed-effects modeling identified glaucoma (β×t =  +0.0141 logMAR/month, p < 0.001) and vitreous opacities (β×t =  +0.0096, p = 0.005) as the sequelae most strongly associated with visual decline. Methotrexate was independently associated with a more favorable visual acuity trajectory (β×t =  -0.0071 logMAR/month, p < 0.001). CONCLUSIONS:Pediatric noninfectious posterior and panuveitis is characterized by chronic, bilateral disease with near-universal sequelae. Glaucoma and vitreous opacities were the strongest drivers of visual decline, while methotrexate was associated with visual preservation, supporting its early use in this population.

PURPOSE:The purpose of the study was to evaluate factors influencing outpatient follow-up adherence among patients receiving ophthalmology consultations in the emergency department (ED). MATERIALS AND METHODS:This retrospective cohort study collected data from the Chang Gung Research Database. Patients who received ophthalmology consultations at the ED of Chang Gung Memorial Hospital Linkou Medical Center from January 1, 2010, to December 31, 2019, were included. Patients were divided into two groups based on whether they completed outpatient follow-up within 28 days, a timeframe consistent with our hospital's scheduling policy. Demographics, ED visit timing, triage categories, ophthalmic diagnoses, prior visits, and ED stay durations were analyzed using logistic regression. RESULTS:A total of 42,530 patients were included (mean age 38.6 ± 20.2 years; 59.2% male), with 38.4% adhering to follow-up and 61.6% not. Nonadherence was associated with younger age (odds ratio [OR]: 0.92; 95% confidence interval [CI]: 0.92-0.93), evening (OR: 1.28; 95% CI: 1.22-1.34) or midnight (OR: 1.94; 95% CI: 1.83-2.06) ED visits, not likely emergent diagnoses (OR: 2.09; 95% CI: 1.96-2.22), and shorter ED stays (<1 h: OR: 3.73; 95% CI: 3.46-4.03). Patients with prior ophthalmology outpatient visits (OR: 0.48; 95% CI: 0.46-0.52) and longer ED stays (more than 3 h) demonstrated better adherence. Over 10 years, emergent diagnoses increased from 51.1% to 69.5%, while non-emergent diagnoses declined from 23.1% to 13.2%. CONCLUSION:Adherence to outpatient follow-up after ophthalmic ED visits was low. Younger age, evening or midnight visits, non-emergent diagnoses, and short ED stays predicted non-adherence, whereas prior outpatient visits and longer ED stays improved adherence.

PURPOSE:To investigate the incidence of ocular hypertension (OHT) after suprachoroidal injection of triamcinolone acetonide (SCS-TA) for noninfectious uveitic macular edema. METHODS:Retrospective review of eyes undergoing SCS-TA. The primary outcome was incidence of OHT (intraocular pressure [IOP] > 24 mmHg). Secondary outcomes included incidence of IOP > 30 mmHg, IOP rise ≥10 mmHg above baseline, and treatment for OHT. RESULTS:Seventy-six eyes of 70 patients were treated with a mean of 1.71 (range 1-5) SCS-TA injections with an average follow-up of 7.6 (range 3.0-14.9) months. Nine eyes (11.8%) developed OHT, four eyes (5.3%) had IOP > 30 mmHg, and nine eyes (11.8%) had an IOP elevation of ≥ 10 mmHg above baseline at any point after their first injection. Eyes that developed OHT were treated with topical therapy (7 eyes, mean 1.9 agents, range 1-4 agents) or close observation (2 eyes). No eyes required incisional glaucoma surgery. Eyes with a history of glaucoma or OHT (7/34, 20.1%) were more likely to develop OHT versus eyes with no history (2/42, 4.8%, P = 0.03). CONCLUSION:In this real-world cohort, SCS-TA was associated with a low-incidence of OHT, consistent with clinical trial data. A history of glaucoma or OHT is a significant association for developing OHT after SCS-TA.

Purpose: To compare 6-month single-surgery anatomic success (SSAS) in eyes with giant retinal tear (GRT)-related retinal detachment (RD) treated with pars plana vitrectomy (PPV) with or without scleral buckle (SB), and to assess whether prophylactic fellow eye treatment reduces long-term GRT or RD risk. Methods: Retrospective multi-center study of eyes with GRT-related RD with ≥6 months follow-up. The primary outcomes were 6-month SSAS after GRT repair and rates of fellow eye GRT and RD. Group differences were assessed with standard univariate tests and logistic regression models. Results: Among 379 eyes of 374 patients with GRT-related RD, PPV/SB was performed in 48.4% and PPV alone in 46.3%. In phakic eyes, higher 6-month SSAS was achieved in the PPV/SB vs PPV group (95.4% vs 83.1%, P=0.005), while in pseudophakic eyes, this PPV/SB benefit was not seen (85.7% vs 84.3%, P=0.82). Proliferative vitreoretinopathy (42.6%) and new retinal tears (22.2%) were the leading causes of re-detachment. Subsequent fellow eye GRT occurred in 5.5% and non-GRT RD in 9.2%. Most patients did not receive prophylactic fellow eye treatment: 7.7% underwent 360° laser and 20.0% received targeted laser. Over a mean follow-up period of 2.8 years, the rates of GRT and RD were similar among fellow eyes treated with circumferential, targeted, or no laser (P ≥ 0.11). Conclusions: Both PPV/SB and PPV achieved high rates of SSAS after GRT-related RD. PPV/SB should be considered particularly in phakic eyes. Prophylactic laser did not decrease the risk of fellow eye GRT or RD over this follow up period.

Purpose:To investigate the incidence and outcomes of rhegmatogenous retinal detachment (RRD) occurring after pars plana vitrectomy and subretinal tissue plasminogen activator for submacular hemorrhage (SMH).Methods:Charts were reviewed between April 1, 2014, and September 1, 2023, for eyes that underwent pars plana vitrectomy/subretinal tissue plasminogen activator for SMH.Results:Of 167 eyes, 15 eyes (9%) developed RRD with macular detachment in 12 eyes (80%) and proliferative vitreoretinopathy (PVR) in nine eyes (60%). The median (interquartile range, IQR) time from pars plana vitrectomy/subretinal tissue plasminogen activator until RRD diagnosis was 41 days (22-81). Thirteen eyes underwent RRD repair and two eyes were observed due to poor visual prognosis. Single-surgery anatomical success was achieved in 11 eyes (85%) at three months and nine eyes (70%) at the final visit. Four eyes (27%) developed redetachment, and three eyes underwent a median of two additional repairs. The final anatomical success rate for reattachment was 92% (12/13). The median (IQR) logarithm of the minimal angle of resolution [Snellen] visual acuity at the preoperative visit after SMH was 2 (2-2.3) [20/2,000], which worsened to 2.3 (2.2-2.7) [20/4,000] at the time of RRD diagnosis (P = 0.01) and plateaued by the final visit to 2.3 (2-2.7) [20/4,000] (P = 0.15).Conclusion:Postoperative RRD occurred in nearly one in 10 eyes after pars plana vitrectomy/subretinal tissue plasminogen activator for SMH and was associated with a relatively high rate of PVR.

PURPOSE OF REVIEW:Post-injection endophthalmitis (PIE) is the most concerning complication that accompanies intravitreal injections. This review discusses the recent literature in endophthalmitis prophylaxis including types of antisepsis, the use of topical antibiotics, methods of anesthesia, masking, and office-based versus operating room-based injections. RECENT FINDINGS:Povidone iodine (PI) remains the gold standard for PIE prophylaxis. Chlorhexidine gluconate (CHG) is an alternative antiseptic agent utilized in other areas of medicine with similar broad spectrum antibacterial activity. Recent clinical trials have demonstrated that the rate of endophthalmitis is similar with CHG prophylaxis compared to PI prophylaxis while offering improved patient comfort at a similar cost. Routine use of topical antibiotics should be avoided as they do not appear to reduce endophthalmitis risk and may promote bacterial resistance. All methods of anesthesia appear to be acceptable. In-office injections are not associated with an increased rate of endophthalmitis compared to operating room injections. SUMMARY:The rate of post-injection endophthalmitis is extremely low due to a myriad of measures employed by retina specialists. Topical antisepsis is the most important tool to combat post-injection endophthalmitis. CHG is emerging as an alternative to PI due to its efficacy and enhanced patient comfort.

Momenaei, Bita MD; Pandit, Saagar A. MD; Wang, Kristine Y.; Wakabayashi, Taku MD, PhD; Hsu, Jason MD; Regillo, Carl D. MD; Klufas, Michael A. MD; Xu, David MD; Cohen, Michael N. MD; Garg, Sunir J. MD, FACS; Kuriyan, Ajay E. MD; Yonekawa, Yoshihiro MD Author Information

Purpose: To compare the outcomes of phakic and pseudophakic eyes with rhegmatogenous retinal detachment (RRD) and proliferative vitreoretinopathy (PVR) that underwent pars plana vitrectomy (PPV) with retinectomy. Methods: A retrospective matched cohort study was performed in patients who underwent PPV with retinectomy for RRD with PVR with a minimum follow-up of 6 months. Phakic eyes that did not undergo lensectomy were matched to pseudophakic control eyes in a 1:1 ratio for age, gender, and macular status. The main outcome measure was single-surgery anatomic success at 6 months. Results: The study included 138 eyes (69 in each of the phakic and pseudophakic groups). The mean follow-up duration was 28.7 ± 9.2 months. Baseline characteristics, including macular status, preoperative visual acuity (VA), and RRD extent and retinectomy did not differ significantly between groups. The single-surgery anatomic success after initial retinectomy did not differ significantly between the phakic and pseudophakic groups at 3 months (69.6% vs 82.6%, respectively; P = .110) or 6 months (56.6% vs 66.7%, respectively; P = .294). The final retinal reattachment was achieved in 98.6% of the phakic group and 97.1% of the pseudophakic group ( P > .99). Both groups showed significant visual improvement at 6 months and final follow-up visit ( P < .05). Postoperative VA did not differ significantly between groups ( P > .05). Conclusions: Eyes that underwent retinectomy for RRD with PVR may achieve acceptable outcomes regardless of the lens status. There was no difference in outcomes between phakic eyes that did not undergo lensectomy and pseudophakic eyes.

PURPOSE:To describe the management patterns and outcomes among patients with incisional glaucoma surgery-associated endophthalmitis. METHODS:Retrospective review of all patients treated for endophthalmitis following standalone incisional glaucoma surgery (trabeculectomy and glaucoma drainage device (GDD) implants at a single institution). Data were recorded on clinical course, microbiological findings, management, and treatment outcomes. RESULTS:A total of 101 eyes with incisional glaucoma surgery-related endophthalmitis were identified, of which 66% (N = 67/101) were trabeculectomy related. The mean (SD) time from surgery to endophthalmitis presentation was 4.9 (6.3) years for trabeculectomies and 3.6 (4.5) years for GDD implant surgery. Most (N = 98/101, 97%) eyes underwent initial treatment with intravitreal antibiotics alone. Of the 98 eyes undergoing initial treatment with intravitreal antibiotics, 14% (N = 14/98) underwent a repeat injection of antibiotics, and 16% (N = 16/98) underwent a subsequent PPV after initial treatment. A higher proportion of eyes with GDD-related endophthalmitis underwent repeat injection with intravitreal antibiotics compared to eyes with trabeculectomy-related endophthalmitis (23.5% vs 9.0%, p = 0.045). The overall culture-positive rate was 30% (N = 26/85), with gram-positive microorganisms being more common. The mean presenting logMAR VA was 2.36 (Snellen equivalent 20/4600). Mean logMAR VA at last follow-up was 1.90 (Snellen equivalent 20/1600), with a mean (SD) follow-up duration of 2.6 (2.8) years. CONCLUSIONS:Visual outcomes following incisional glaucoma surgery-associated endophthalmitis remain guarded. Most patients were managed with intravitreal antibiotics alone. Eyes with GDD-related endophthalmitis may be more likely to undergo repeat injection of intravitreal antibiotics.

PURPOSE OF REVIEW:To review the role of microbial cultures in managing endophthalmitis following cataract surgery and intravitreal injections. RECENT FINDINGS:The endophthalmitis vitrectomy study (EVS) continues to guide the management of endophthalmitis including its recommendation for intraocular vitreous sampling. Vitreous cultures have better diagnostic yield than aqueous cultures. Advances in culture techniques have improved the efficiency and sensitivity of pathogen identification. While culture results are useful for prognostication, microbiology data rarely changes management in endophthalmitis following cataract surgery or intravitreal injections. Endophthalmitis managed without microbial cultures had similar outcomes to eyes managed with microbial cultures. SUMMARY:Despite advances in culture techniques, most institutions still rely on gram stain and microbial cultures, often requiring several days for results. Initial administration of empiric antibiotics occurs before microbiology data becomes available, limiting the utility of cultures in clinical management. Despite concerns for antibiotic resistance, the large majority of postcataract surgery and postintravitreal injection endophthalmitis pathogens are susceptible to vancomycin and ceftazidime. Given this, obtaining intraocular specimens can be deferred if it poses a delay to prompt treatment with intravitreal antibiotics. Emerging culture techniques hold promise for more rapid and sensitive pathogen identification, which could change the landscape of culture guidelines and improve clinical usefulness.