Management of Acute-Onset Exogenous Endophthalmitis in French University Hospitals: A Multicenter Retrospective Study

This study aimed to describe current management practices for acute-onset postoperative endophthalmitis in French university hospitals and to compare visual outcomes between vitrectomy plus intravitreal injections of antibiotics (IVI) and IVI alone. This retrospective multicenter study conducted between January 2021 and July 2024 across seven French hospital centers, included 264 patients using CIM-10 diagnostic codes (H44.0, H44.1, H45.1). Best-corrected visual acuity (BCVA) was converted to logMAR. The primary outcome was the change in BCVA at 6 months ± 2 months. The mean age was 77.5 ± 11.1 years, and the female-to-male ratio was 157:107. Endophthalmitis occurred following intravitreal injection in 129 patients (48.9%), phacoemulsification in 99 (37.5%), and vitreoretinal surgery in 21 (7.9%). The remaining 15 patients (5.7%) had other forms of endophthalmitis. Mean baseline BCVA was 1.9 logMAR. Among 154 patients with complete follow-up, 108 received IVI alone (IVI alone group) and 46 vitrectomy plus IVI (vitrectomy plus IVI group). Univariate analysis showed no significant difference in BCVA change ( P > 0.05) between the two groups. However, on multivariate analysis, vitrectomy plus IVI group showed worse visual recovery compared with IVI alone group ( β = + 0.68, P = 0.003). Repeated IVI did not improve outcome compared with IVI injections performed once ( P > 0.05). The overall microbiological positivity rate was 29.7% (71/239), with Gram-positive cocci accounting for most cases. Staphylococcus epidermidis was associated with better visual recovery than other organisms in this unadjusted, exploratory comparison ( P = 0.03). Systemic antibiotic regimens varied considerably across centers. The present retrospective study showed better 6-month visual recovery in acute-onset postoperative endophthalmitis treated by IVI alone compared with vitrectomy plus IVI, although this finding was confined to the post hoc multivariable analysis and needs prospective confirmation before affirming that IVI alone is sufficient as first-line therapy in acute-onset postoperative endophthalmitis.