Treatment of Postoperative Endophthalmitis

Abstract

Despite many advances in microsurgery, asepsis, antibiotics and intraocular lenses, postoperative endophthalmitis continues to be responsibe for the loss of many eyes. In a series of 153 cases of endophthalmitis with a positive culture, 115 occurred after ophthalmic surgery. Eyes appear to be more vulnerable to this complication after extracapsular lens extraction in particular. The analysis of the patients operated for cataract in our own department shows that the incidence of endophthalmitis is 3 times higher in the extracapsular group with lens implantation than in the group of intracapsular lens extraction without lens implantation. Quick diagnosis and prompt action are essential to successful treatment. The treatment consists of vitrectomy and has the following three purposes: (1) provision of a good specimen for direct bacteriological examination and culture; (2) removal of toxins and cells, and (3) creation of space for the injection of an antibiotic. The authors found highly divergent prognoses and bacteriological patterns for endophthalmitis following vitrectomy, bleb surgery and cataract. Similar bacteriological agents do not give rise to the same prognosis after different operations. The post-lens implantation group (88 cases) permitted a distinction to be made between intracapsular and extracapsular surgery. A statistically significantly higher percentage of infection by low-virulence organisms (e.g. Staphylococcus epidermidis) was seen after extracapsular surgery: 60% compared to 30%. The analysis shows that this difference in bacteriological spectrum is the sole explanation for the better functional results following extracapsular surgery.

Incidence of presumed postoperative endophthalmitis in Dublin for a 5-year period (1997–2001)

“…This supports studies that have shown that the use of intravitreal antibiotics rather than just systemic antibiotics combined with topical steroids gave a better visual outcome. 11,12 Our findings also support the endophthalmitis vitrectomy trial in which patients who received immediate intravitreal antibiotics achieved a visual outcome of 20/100 or better in 84% of cases. 13 Our hospital has had an endophthalmitis policy in place since 1996 that makes recommendations for treatment in keeping with the Endophthalmitis Vitrectomy Study, but these recommendations are not always adhered to and treatment of these cases is usually dependent on the consultant surgeon in charge.…”

Fabrication of nonfouling, bactericidal, and bacteria corpse release multifunctional surface through surface-initiated RAFT polymerization

“…1,2 Despite the enormous progress made in asepsis, microsurgical techniques, suture materials, prosthetic materials, and antibiotics, postoperative endophthalmitis continues to be a great threat to ophthalmology patient vision. 3 The incidence of endophthalmitis after cataract removal and IOL implantation is estimated between 0.07% and 0.12% in the developed countries; in the developing nations, the situation is even worse. 4,5 Although the incidence is not high, endophthalmitis is a significant postoperative morbidity after cataract surgery.…”

A review of preoperative manoeuvres for prophylaxis of endophthalmitis in intraocular surgery

“…However, because of the sheer numbers of surgeries, 90% of cases are associated with cataract surgery [4]. The rate of endophthalmitis associated with cataract extraction was reported to be 0.087% in 1990 and is reported to be 0.265% as of 2000 [5].…”