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Clinical Alert: To Ophthalmologists -- Findings from the EndophthalmitisVitrectomy Study (EVS)

National Eye Institute (NEI)
October 13, 1995

Abstract:

(The full text of this Alert is contained in the Abstract.)

Dear Colleague:

This letter is to inform you of findings from the Endophthalmitis Vitrectomy Study (EVS) that warrant your attention prior to publication of the results. This randomized, controlled clinical trial is supported by the National Eye Institute (NEI), part of the U.S. National Institutes of Health, and was conducted at 27 clinical centers nationwide.

The purpose of the EVS was:

  • To determine the role of immediate pars plana vitrectomy in the management of endophthalmitis occurring after cataract surgery or secondary intraocular lens implantation.
  • To determine the role of intravenous antibiotics in the management of endophthalmitis.

EVS patients had clinical evidence of bacterial endophthalmitis within six weeks of cataract surgery or secondary lens implantation. The involved eye had 1) either hypopyon or enough clouding of anterior chamber or vitreous media to obscure clear visualization of second-order retinal arterioles; 2) a cornea and anterior chamber in the involved eye clear enough to visualize some part of the iris; and, 3) a cornea clear enough to allow the possibility of pars plana vitrectomy. To enter the study, the patient had to have visual acuity worse than 20/50, but at least light perception.

The study received and analyzed outcome data from 420 patients who were randomly assigned to either immediate pars plana vitrectomy (VIT) or to vitreous tap or biopsy (TAP). They also were randomly assigned to either intravenous antibiotic treatment or to no intravenous treatment. All patients received intravitreal antibiotics.

A final outcome evaluation of visual acuity was assessed at 9-12 months and the results indicated that:

  • There was no difference in final visual acuity or media clarity whether or not systemic antibiotics were employed.
  • Patients who presented with hand motions or better vision did equally well whether they had immediate vitrectomy or immediate tap/biopsy.
  • Patients who presented with vision of light perception only had much better visual results with immediate pars plana vitrectomy than with tap/biopsy. With vitrectomy, these patients were three times more likely to achieve 20/40 final vision (33% compared to 11%), twice as likely to achieve 20/100 final vision (56% compared to 30%), and less than one half as likely to incur severe visual loss of less than 5/200 (20% compared to 47%).

Based on the above results, we conclude that routine immediate vitrectomy was of no additional benefit in patients who met EVS entry criteria and presented with hand motions or better vision. However, immediate vitrectomy was of substantial benefit for those who presented with light perception only vision. In addition, systemic antibiotics provided no additional advantage to final visual outcome.

A scientific paper was submitted to the Archives of Ophthalmology for expedited review, and will be published in the December 1995 issue of the journal. In addition, a symposium presenting the EVS results will occur at the annual meeting of the American Academy of Ophthalmology in Atlanta on Thursday, November 2, 1995, at 10:00 a.m.

If you have any questions about these study findings or related to the management of individual patients, please contact the study's coordinating center at (412) 624-1607 for information and/or referral to one of the EVS principal investigators.

Sincerely,

Carl Kupfer, M.D.
Director
National Eye Institute

Bernard H. Doft, M.D.
Study Chair, EVS
Retina-Vitreous Consultants
Pittsburgh, PA

Sheryl Kelsey, Ph.D.
Director, EVS Coordinating Center
Department of Epidemiology
University of Pittsburgh


Participants List


California

Pedro F. Lopez, M.D.
Department of Ophthalmology
University of Southern California
450 San Pablo Street-DOH 4703
Los Angeles, California 90033
Telephone: (213) 342-6450
Fax: (213) 342-6440
Lon S. Poliner, M.D.
4150 Regents Park Row, Suite 200
La Jolla, California 92037
Telephone: (619) 558-9666

District of Columbia

Howard P. Cupples , M.D.
Department of Ophthalmology, PHC7
Georgetown University Medical Center
3800 Reservoir Road, NW
Washington, D.C. 20007
Telephone: (202) 687-4755

Florida

Mark E. Hammer, M.D.
South Tampa Medical Center
508 S. Habana Avenue, Suite 120
Tampa, Florida 33609
Telephone: (813) 875-6373
Peter Reed Pavan, M.D.
The USF Eye Institute
University of South Florida
12901 B.B. Downs Boulevard
Tampa, Florida 33612-9400;
Telephone: (813) 974-3820

Georgia

Antonio Capone, Jr., M.D.
Emory Eye Center, 5th Floor
Emory University
1327 Clifton Road, N.E.
Atlanta, Georgia 30322
Telephone:(404) 248-3956

Illinois

Kirk H. Packo, M.D.
Illinois Retina Associates Service Corporation
71 West 156th Street, Suite 400
Harvey, Illinois 60426
Telephone: (708) 596-8710
Fax: (703) 596-9820

Kentucky

Charles C. Barr, M.D.
Department of Ophthalmology
Kentucky Lions Eye Research Institute
University of Louisville
301 East Muhammad Ali Blvd.
Louisville, Kentucky 40202
Telephone: (502) 488-5466

Maryland

Peter Campochiarro, M.D.
Wilmer Eye Institute; Maumenee 719
The Johns Hopkins Medical Institutions
600 North Wolfe Street
Baltimore, Maryland 21218-9277
Telephone: (410) 955-5106
Richard A. Garfinkel, M.D.
Retina Group of Washington
5454 Wisconsin Avenue
Suite 1540
Chevy Chase, Maryland 20815
Telephone: (301) 656-8100
Vinod Lakhanpal, M.D.
Eye Associates
University of Maryland
419 West Redwood Street
Baltimore, Maryland 21201
Telephone: (410) 328-5906

Massachusetts

Donald D'Amico, M.D.
Massachusetts Eye & Ear Infirmary
243 Charles Street
Boston, Massachusetts 02114
Telephone: (617) 573-3291

Michigan

Raymond R. Margherio, M.D.
Associated Retinal Consultants, P.C.
Royal Oak Center
3535 West Thirteen Mile Road
Suite 636
Royal Oak, Michigan 48073
Telephone: (313) 288-2280
Andrew K. Vine, M.D.
Kellogg Eye Center
University of Michigan
1000 Wall Street
Ann Arbor, Michigan 48105
Telephone: (313) 763-0482

Minnesota

Herbert L. Cantrill, M.D.
6363 France Avenue South, Suite 570
Edina, Minnesota 55435
Telephone: (612) 929-1131
Mark W. Balles, M.D.
Department of Ophthalmology
University of Minnesota
Box 493 UMHC, Room 9-240 PWB
516 Delaware Street, S.E.
Minneapolis, Minnesota 55455
Telephone: (612) 625-4400

New Jersey

David L. Yarian, M.D.
Retina-Vitreous Center, P.A.
Medi-Plex Suite 310
98 James Street
Edison, New Jersey 08820
Telephone: (908) 906-1887

Ohio

Robert B. Chambers, D.O.
Ohio State University
456 West 10th Avenue
Columbus, Ohio 43210
Telephone: (614) 293-8041
Phillip T. Nelson, M.D.
Retina Consultants of NW Ohio
JOBST Tower, Suite E
2109 Hughes Drive
Toledo, Ohio 43606
Telephone: (419) 479-6180
Ira K. Orgel, M.D.
Retina Vitreous Associates
2213 Cherry Street, Suite 400
Toledo, Ohio 43608
Telephone: (419) 321-4367
Thomas A. Rice, M.D.
Retina Associates of Cleveland
26900 Cedar Road, Suite 303
Beachwood, Ohio 44122
Telephone: (216) 831-5700
Fax: (216) 831-1959

Oklahoma

Reagan H. Bradford, Jr., M.D.
Dean A. McGee Eye Institute
University of Oklahoma
608 Stanton L. Young Boulevard
Oklahoma City, Oklahoma 73104
Telephone: (405) 271-7232

Pennsylvania

Bernard H. Doft, M.D.
Retina Vitreous Consultants
3501 Forbes Avenue, Suite 500
Pittsburgh, Pennsylvania 15213
Telephone: (412) 683-5300
Fax: (412) 621-4833
Thomas Gardner, M.D.
Department of Ophthalmology
College of Medicine
The Pennsylvania State University
Hershey, Pennsylvania 17033
Telephone: (717) 531-8783
Gary C. Brown, M.D.
Retinovitreous Associates
910 East Willow Grove
Philadelphia, Pennsylvania 19118
Telephone: (215) 233-4300

Texas

H. Michael Lambert, M.D.
Baylor College of Medicine
Smith Tower, Suite 1501
6550 Fannin Boulevard
Houston, Texas 77030
Telephone: (713) 798-6100

Wisconsin

Dennis P. Han, M.D.
Medical College of Wisconsin Eye Institute
Milwaukee County Medical Complex
8700 West Wisconsin Avenue
Milwaukee, Wisconsin 53226
Telephone: (414) 257-5341
Fax: (414) 257-7353

RESOURCE CENTERS


Chairman's Office

Bernard H. Doft, M.D.
Retina-Vitreous Consultants
3501 Forbes Avenue, Suite 500
Pittsburgh, Pennsylvania 15213
Telephone: (412) 683-5300
Fax: (412) 621-4833

Coordinating Center

Sheryl F. Kelsey, Ph.D.
Department of Epidemiology
University of Pittsburgh
127 Parran Hall
130 DeSoto Street
Pittsburgh, Pennsylvania 15261
Telephone: (412) 624-1607

Fundus Photograph Reading Center

Matthew D. Davis, M.D.
Department of Ophthalmology
University of Wisconsin
417 WARF Building
610 North Walnut
Madison, Wisconsin 53705
Telephone: (608) 263-4538
Fax: (608) 263-0525

The full text of this alert has been mailed to all libraries that are members of the National Network of Libraries of Medicine.