The EVIAN trial, led by Moorfields Eye Hospital, investigated whether early vitrectomy combined with intravitreal antibiotics could improve visual outcomes in patients with postoperative endophthalmitis. The feasibility trial successfully demonstrated that a larger definitive randomised trial is possible and showed a promising signal towards better visual recovery with early surgery.
Endophthalmitis is a rare but potentially devastating complication following intraocular surgery or intravitreal procedures and can result in severe, irreversible visual loss. The EVIAN study compared early pars plana vitrectomy, performed within 48–96 hours, together with intravitreal antibiotics, with standard treatment consisting of repeated intravitreal antibiotics and delayed vitrectomy when required.
The multicentre UK trial recruited 63 patients across 15 NHS ophthalmic centres. At 24 weeks, the median improvement in visual acuity was 40 ETDRS letters in the early-vitrectomy group compared with 13 letters in the standard-care group in the per-protocol analysis. Although this difference did not reach statistical significance, the findings provide an encouraging signal that earlier vitrectomy may improve visual recovery.
The study also found fewer retinal detachments in the early-vitrectomy group, with retinal detachment occurring in 6.7% compared with 24% in the standard-care group. Importantly, the trial met its primary feasibility endpoint, supporting the development of a larger definitive phase 3 randomised controlled trial.
Published in July 2026, the EVIAN trial represents an important step towards redefining the contemporary management of postoperative endophthalmitis and evaluating whether early surgical intervention should become part of standard treatment.
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