Endophthalmitis.
Australia and New Zealand continue to be at the forefront of endophthalmitis research. In this Clinical Controversy, an ophthalmologist from each country presents different approaches to the management of a 72-year-old patient with routine endophthalmitis following cataract surgery. Mark Elder concludes that this case needs aqueous and vitreous aspirates for culture and the initial treatment of choice is intracameral vancomycin and amikacin. The evidence for intravitreal steroids is equivocal. Systemic antibiotics are indicated if there is a possibility of a bacterial biofilm present on the intraocular lens. Nigel Morlet concludes that timely intervention with appropriate antibiotics delivered in the right concentration to the vitreous cavity is the crux of successful management of endophthalmitis. Aggressive treatment of the inflammatory response is also required to further reduce the damage to the intraocular structures. Both ophthalmologists agree that vitrectomy is not necessarily the most appropriate treatment option.
Elder
Mark J
MJ
Christchurch School of Medicine, University of Otago, Christchurch, New Zealand. mark.elder@cdhb.govt.nz
Morlet
Nigel
N
D000368:Aged; D000583:Amikacin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001082:Aqueous Humor / Q000382:microbiology; D001419:Bacteria / Q000302:isolation & purification; D002387:Cataract Extraction / Q000009:adverse effects*; D009877:Endophthalmitis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D015818:Eye Infections, Bacterial / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D014640:Vancomycin / Q000627:therapeutic use; D014821:Vitrectomy; D014822:Vitreous Body / Q000382:microbiology
D000900:Anti-Bacterial Agents; D005938:Glucocorticoids; D014640:Vancomycin; D000583:Amikacin