Outcomes of Endogenous Klebsiella pneumoniae Endophthalmitis With and Without Vitrectomy: A Meta-Analysis of Individual Participant Data.
Journal
Clinical & experimental ophthalmology
Journal Volume
53
Journal Issue
7
Start Page
813
End Page
824
ISSN
1442-9071
Date Issued
2025
Author(s)
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.
Subjects
Klebsiella pneumoniae
endophthalmitis
meta‐analysis
visual acuity
vitrectomy
SDGs
Type
journal article