Outcomes of Endogenous Klebsiella pneumoniae Endophthalmitis With and Without Vitrectomy: A Meta-Analysis of Individual Participant Data.

Abstract

Background: The use of vitrectomy in treating endogenous Klebsiella pneumoniae endophthalmitis (EKPE) remains controversial. This study aims to compare visual and anatomical outcomes of EKPE with and without vitrectomy.

Methods: A meta-analysis of individual participant data with relevant studies identified from PubMed, Embase and Web of Science. Patients were classified into the vitrectomy and non-vitrectomy groups (patients who received IVI antibiotics alone). Poor visual acuity (VA) was defined as hand motion (HM) or worse. A generalised linear mixed model (for within-study comparisons) and generalised estimating equations (for single-arm studies) were used in the first stage of data synthesis, followed by a secondary meta-analysis to integrate the effect estimates through a fixed-effect model. The primary outcomes included differences in VA improvements, risks of poor final VA and risks of globe preservation failure between the vitrectomy and non-vitrectomy groups.

Results: Of 68 retrospective studies, 324 patients (383 eyes) were included. Overall, VA improvement was significantly better in the vitrectomy group (mean differences [MD] = -0.27; p < 0.01). When stratified by initial VA, the result remained robust in eyes with poor initial VA (MD = -0.35; p < 0.01). There were no significant differences in risks of poor final VA (odds ratio [OR] = 0.84; p = 0.64) and risks of globe preservation failure (OR = 0.42; p = 0.09) between the two groups.

Conclusions: Vitrectomy results in greater VA improvement than IVI antibiotics alone in the management of EKPE, especially in eyes with an initial VA of HM or worse.