nlmpubs.nlm.nih.gov/2014.05.nlmpubs.nlm.nih.gov.tar/nlmpubs.nlm.nih.gov/alerts/ophthal.txt

Text File | 1995-10-12 | 12KB | 240 lines

Clinical Alert: To Ophthalmologists -- Findings from the Endophthalmitis
Vitrectomy Study (EVS).
National Eye Institute (NEI)
October 13, 1995

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 [phone] 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: [phone]; Fax: [phone]
-----------------------------------------------------
Lon S. Poliner, M.D.;  4150 Regents Park Row, Suite 200; La Jolla,
      California 92037; Telephone:  [phone]
-----------------------------------------------------
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:  [phone]
-----------------------------------------------------
Florida
-----------------------------------------------------
Mark E. Hammer, M.D.;  South Tampa Medical Center; 508 S. Habana
      Avenue, Suite 120; Tampa, Florida 33609; Telephone: [phone]
-----------------------------------------------------
Peter Reed Pavan, M.D.;  The USF Eye Institute; University of South
      Florida; 12901 B.B. Downs Boulevard; Tampa, Florida 33612-9400;
      Telephone:  [phone]
-----------------------------------------------------
Georgia
-----------------------------------------------------
Antonio Capone, Jr., M.D.;  Emory Eye Center, 5th Floor; Emory
      University; 1327 Clifton Road, N.E.;  Atlanta, Georgia 30322;
      Telephone:[phone]
-----------------------------------------------------
Illinois
-----------------------------------------------------
Kirk H. Packo, M.D.;  Illinois Retina Associates Service Corporation;
      71 West 156th Street, Suite 400; Harvey, Illinois 60426; Telephone:
      [phone]; Fax: [phone]
-----------------------------------------------------
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:  [phone]
-----------------------------------------------------
Maryland
-----------------------------------------------------
Peter Campochiarro, M.D.;  Wilmer Eye Institute; Maumenee 719; The
      Johns Hopkins Medical Institutions; 600 North Wolfe Street; Baltimore,
      Maryland 21218-9277; Telephone:  [phone]
-----------------------------------------------------
Richard A. Garfinkel, M.D.;  Retina Group of Washington; 5454
      Wisconsin Avenue; Suite 1540; Chevy Chase, Maryland 20815; Telephone:
      [phone]
-----------------------------------------------------
Vinod Lakhanpal, M.D.;  Eye Associates; University of Maryland; 419
      West Redwood Street; Baltimore, Maryland 21201; Telephone:
      [phone]
-----------------------------------------------------
Massachusetts
-----------------------------------------------------
Donald D'Amico, M.D.;  Massachusetts Eye & Ear Infirmary; 243 Charles
      Street; Boston, Massachusetts 02114; Telephone: [phone]
-----------------------------------------------------
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: [phone]
-----------------------------------------------------
Andrew K. Vine, M.D.;  Kellogg Eye Center; University of Michigan;
      1000 Wall Street; Ann Arbor, Michigan 48105; Telephone: [phone]
-----------------------------------------------------
Minnesota
-----------------------------------------------------
Herbert L. Cantrill, M.D.;  6363 France Avenue South, Suite 570;
      Edina, Minnesota 55435; Telephone: [phone]
-----------------------------------------------------
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:  [phone]
-----------------------------------------------------
New Jersey
-----------------------------------------------------
David L. Yarian, M.D.;  Retina-Vitreous Center, P.A.;  Medi-Plex
      Suite 310; 98 James Street; Edison, New Jersey 08820; Telephone:
      [phone]
-----------------------------------------------------
Ohio
-----------------------------------------------------
Robert B. Chambers, D.O.;  Ohio State University; 456 West 10th
      Avenue; Columbus, Ohio 43210; Telephone:  [phone]
-----------------------------------------------------
Phillip T. Nelson, M.D.;  Retina Consultants of NW Ohio; JOBST Tower,
      Suite E; 2109 Hughes Drive; Toledo, Ohio  43606; Telephone:
      [phone]
-----------------------------------------------------
Ira K. Orgel, M.D.;  Retina Vitreous Associates; 2213 Cherry
      Street,Suite 400; Toledo, Ohio 43608; Telephone:  [phone]
-----------------------------------------------------
Thomas A. Rice, M.D.;  Retina Associates of Cleveland; 26900 Cedar
      Road, Suite 303; Beachwood, Ohio 44122; Telephone: [phone];
      Fax: [phone]
-----------------------------------------------------
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:  [phone]
-----------------------------------------------------
Pennsylvania
-----------------------------------------------------
Bernard H. Doft, M.D.;  Retina Vitreous Consultants; 3501 Forbes
      Avenue, Suite 500; Pittsburgh, Pennsylvania 15213; Telephone:
      [phone]; Fax: [phone]
-----------------------------------------------------
Thomas Gardner, M.D.;  Department of Ophthalmology; College of
      Medicine; The Pennsylvania State University; Hershey, Pennsylvania
      17033; Telephone:  [phone]
-----------------------------------------------------
Gary C. Brown, M.D.;  Retinovitreous Associates; 910 East Willow
      Grove; Philadelphia, Pennsylvania 19118; Telephone:  [phone]
-----------------------------------------------------
Texas
-----------------------------------------------------
H. Michael Lambert, M.D.;  Baylor College of Medicine; Smith Tower,
      Suite 1501; 6550 Fannin Boulevard; Houston, Texas 77030; Telephone:
      [phone]
-----------------------------------------------------
Wisconsin
-----------------------------------------------------
Dennis P. Han, M.D.;  Medical College of Wisconsin Eye Institute;
      Milwaukee County Medical Complex; 8700 West Wisconsin Avenue;
      Milwaukee,Wisconsin 53226; Telephone: [phone]; Fax:
      [phone]
=====================================================
RESOURCE CENTERS
=====================================================
Chairman's Office -  Bernard H. Doft, M.D.;  Retina-Vitreous
      Consultants; 3501 Forbes Avenue, Suite 500; Pittsburgh, Pennsylvania
      15213; Telephone: [phone]; Fax: [phone]
-----------------------------------------------------
Coordinating Center -  Sheryl F. Kelsey, Ph.D.;  Department of
      Epidemiology; University of Pittsburgh; 127 Parran Hall; 130 DeSoto
      Street; Pittsburgh, Pennsylvania 15261; Telephone: [phone]
-----------------------------------------------------
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: [phone]; Fax:
      [phone]

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