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.
Last Reviewed: March 12, 2018