Infectious endophthalmitis

There have been numerous advances in both the diagnosis and management of infectious endophthalmitis. The recently published results of the Endophthalmitis Vitrectomy Study further added to our understanding of the microbiological features, clinical course, and management of postoperative infectious endophthalmitis. The Endophthalmitis Vitrectomy Study confirmed that the Gram-positive coagulase-negative organisms are the most common cause of acute endophthalmitis after cataract or secondary intraocular lens surgery. The Endophthalmitis Vitrectomy Study also confirmed the efficacy of treatment with intravitreal vancomycin and amikacin. In this study, an immediate pars plana vitrectomy yielded better visual acuity outcomes when compared with a vitreous aspiration or biopsy in eyes with light-perception-only vision. The study did not demonstrate a difference between groups (vitrectomy versus tap/biopsy) in eyes with better than light-perception-only visual acuity. Finally, the study demonstrated that in the Endophthalmitis Vitrectomy Study systemic antibiotics (amikacin and ceftazidime) were not of benefit judged by the outcome of final visual acuity and media clarity. Newer, less toxic, antifungal agents with good intraocular penetration are available to supplement the treatment of endogenous fungal endophthalmitis.