Postoperative Endophthalmitis

Abstract

Postoperative endophthalmitis remains a serious clinical problem in ophthalmology, with an incidence of approximately 0.5%. Prognosis is largely determined by the virulence of the offending organism. The Endophthalmitis Vitrectomy Study (EVS) was a prospective, randomized trial comparing various diagnostic and treatment modalities in cases of endophthalmitis that followed cataract surgery. The EVS found that vitrectomy was only beneficial for patients presenting with very poor visual acuity and that intravenous antibiotic treatments had no additional benefit, compared with intravitreal antibiotic therapy alone. However, weaknesses of the EVS leave these conclusions open to modification in the future. Preoperative application of povidone-iodine preparation to the skin and conjunctiva is the only proven endophthalmitis prophylaxis. Endophthalmitis may be chronic and may follow glaucoma surgery and intravitreal injection of gas and drugs. The EVS did not study these issues, although they are associated with specific features that may require alterations in patient management.

Endophthalmitis: Gram Positive Ethiological Agents and Susceptibility to Glycopeptides

“…A rapid antibiotic therapy is the only way of treatment. For this reason, an empiric antibiotic therapy done with wide spectrum drugs has to be started before the identification of the etiological agent [2,12]. On the contrary the use of steroid does not find a unanimous consensus [20].…”

“…This kind of endophthalmitis is one of the most serious and deleterious condition after the surgical treatment of cataract with an incidence of 0.13-0.7 % [2,4,5].…”

“…Nevertheless, more recent studies have shown that the intravitreal penetration of antibiotics is more efficient when compared with the systemic use of them [2]. A wide spectrum scheme of treatment, waiting for cultural test responses, is due by the association of a -lactamine and a glycopeptide (vancomycin) [2].…”

Stenotrophomonas maltophilia Induced Post-Cataract-Surgery Endophthalmitis: Outbreak Investigation and Clinical Courses of 26 Patients

“…Staphylococcus epidermidis is the most common pathogen isolated in culture-proven endophthalmitis (60% of cases), Staphylococcus aureus, Streptococcus spp., and Enterococcus spp. are each found in 5%-10%, and other Gram-negative bacteria are found in 6% of cases [1]. Isolated microorganisms usually represent the preoperative, endogenous colonization of the patients' eyelids and conjunctivae, but might also originate from unusual exogenous sources, e.g., contaminated surgical material or ocular rinsing solution.…”

The Effect of Intravitreally Injected Povidone-Iodine onStaphylococcus epidermidisin Rabbit Eyes

“…PVP-I is effective in treating bacterial conjunctivitis, as a postoperative antibacterial, for preoperative prophylaxis, in combination with antibiotics topically, for prophylaxis against ophthalmia neonatorum, and for various other ophthalmologic uses. [4][5][6][7][8][9][10] Despite the efficacy of PVP-I against various pathogens, research is ongoing as to the toxicity of PVP-I in ocular tissues. Naor and colleagues demonstrated that while 0.1% PVP-I is well tolerated on the corneal endothelium in-vivo, 1.0% is not.…”