New management algorithm for acute post cataract endophthalmitis
Reviewed by Su Young

In this study, the authors aimed to establish an objective algorithm for recommending urgent pars plana vitrectomy (PPV) to help improve visual outcomes in the current era of clear corneal-incision phacoemulsification and small gauge PPV. This study examined 150 cases of acute postoperative cataract to identify outcomes based on the ACES scoring system for acute postop endophthalmitis in cataract surgery. The full scoring system is detailed in the article; some parameters used in scoring for the algorithm included presenting vision, age, intraocular pressure, anterior chamber activity, posterior view, presentation with pain, and diabetic status. Patients whose clinical course followed the ACES score recommendation for immediate surgery had significantly (P < 0.01) better final best corrected visual acuity (BCVA) (median = 0.18 logMAR, 20/30 Snellen) compared to those who deviated (median = 0.70 logMAR, 20/100 Snellen). For those where the ACES score deemed urgent PPV was unnecessary, no significant (P = 0.19) difference was observed between patients that followed with (median = 0.18 logMAR, 20/30 Snellen) and those who deviated from (median = 0.10 logMAR, 20/25 Snellen) recommendation. The authors conclude that the ACES score may potentially provide critical and updated management guidance for urgent PPV for acute postoperative endophthalmitis from cataract surgery at presentation.

Evaluation of outcomes of acute cataract surgery-related endophthalmitis using a novel management algorithm based on presenting risk factors.
Adams OE, Vagaggini T, Growth SL, et al.
SEMINARS IN OPHTHALMOLOGY
2023;38(7):648-55.