Endophthalmitis Rx Protocol

Treatment Protocol for Postoperative Endophthalmitis-Concise guide lines-Mazhry

Copyright © 2016

Chashm-e-Beena Publishers

Acuity Eye Center

14-G-3 WAPDA Town Lahore Pakistan

All rights reserved

Printed in Pakistan

Design, production, editing and illustrations by Dr. Mazhry.

Endophthalmitis is a devastating complication of ocular surgery and trauma, which may lead to total loss of vision and sometimes even the eyeball.1,2Postoperative endophthalmitis is an inflammatory condition of the eye, presumed to be due to an infectious process from bacteria, fungi or, on rare occasions, parasites that enter the eye during the perioperative period.3,4Management of endophthalmitis presents one of the most challenging problems in ophthalmology. Two third of all cases of endophthalmitis occur after surgery. 90% are caused by bacteria and the remaining 10% by fungi, viruses, and parasites. Incidence reported in the literature is 0.1% to 0.4%. Though no study is available locally, incidence in our setup seems to be even higher.

Traditionally endophthalmitis had been treated with topical and systemic antibiotics given both orally as well as parenterally but with a poor therapeutic response. Another mode of treatment that has become the standard treatment for endophthalmitis is an intravitreal injection of antimicrobials. Studies have proven this to be an effective, probably the only effective treatment available so far.

The authors carried out a study on 56 eyes diagnosed as cases of endophthalmitis.5 The patients were treated with intravitreal injections. Results were encouraging. Anatomical integrity was preserved in 90% of cases and 60% had a visual acuity of 6/60 or better. A gold medal winning paper was presented by one of the authors in Ophthalmo 96 based on the above study. Great enthusiasm was shown about the technique. The Chairman of the conference advised publishing the technique.5

Endophthalmitis Vitrectomy Study (EVS) was completed in 1995. It had a great impact on endophthalmitis management recommendations. The study standardized the protocol of post cataract surgery endophthalmitis.6

The aim of this booklet is to present in a simple way for management of endophthalmitis using the technique of intravitreal injections. Secondly, we want to decrease the undue hesitancy and fear about the use of intravitreal injections. By the end of the booklet, the reader will feel confident to practice the procedure on his own whenever and wherever needed.