Early vitrectomy and intravitreal antibiotics for post-operative exogenous endophthalmitis (EVIAN): a…

Randomized trialCommunications medicine· Jul 2026

Early vitrectomy and intravitreal antibiotics for post-operative exogenous endophthalmitis (EVIAN): a randomised control trial of feasibility.

Mahiul Mk Muqit, Carlos Pavesio, Yanzhong Wang … James Bainbridge

UveitisRandomized trialQ1IF 7.4

A trial testing early vitrectomy for endophthalmitis proved feasible, recruiting most eligible patients.

Early vitrectomy and intravitreal antibiotics for post-operative exogenous endophthalmitis (EVIAN): a randomised control trial of feasibility.

Mahiul Mk Muqit … James Bainbridge

Communications medicine · Jul 2026 · Q1 in General Medicine

Background

Endophthalmitis is a blinding complication following any invasive ocular procedure, and historical treatment guidelines do exist but only for cataract surgery cases.

Purpose

We conducted a multicentre, national prospective randomized controlled clinical (RCT) trial aimed to assess the feasibility of randomizing patients to an early vitrectomy (Arm-A) intervention within 48-96 hours compared to current standard patient care of repeated, immediate intravitreal antibiotic injection (Arm-B) and delayed vitrectomy.

Methods

There was no blinding or masking conducted in the trial.

n = 63 participants

79%

Results

79%

of eligible patients agreed to join, showing the trial design works

n = 63 participants

More results

Median change in visual acuity (IQR) as per-protocol from baseline-to-week 24 was 40 (28-70) letters in Arm-A (n = 24) versus 13 (0-66) letters in Arm-B (n = 25); corresponding to a between-group difference of 24 letters, adjusted for baseline, in favour of early vitrectomy (p = 0.139).

More results

Higher rate of non-serious adverse events observed in Arm-B (68%) compared to Arm-A (47%), with higher incidence of retinal detachment 8 cases (24%) in Arm-B versus 2 cases in Arm-A (6.7%).

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Conclusion · 1 of 2

The EVIAN trial meets the primary endpoint demonstrating feasibility in conducting a trial to randomize the target population at multiple eye centres.

Conclusion · 2 of 2

Although not statistically significant, the effect on visual acuity change indicates a potential meaningful benefit of vitrectomy compared to standard of care treatment, which can now be tested in a definitive phase 3 clinical trial.

Early vitrectomy and intravitreal antibiotics for post-operative exogenous endophthalmitis (EVIAN): a randomised control trial of feasibility.

Early vitrectomy and intravitreal antibiotics for post-operative exogenous endophthalmitis (EVIAN): a randomised control trial of feasibility.

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