Acute postoperative
endophthalmitis is treated by a combination of broad-spectrum
antibiotics (
vancomycin and
ceftazidime or
amikacin), which are administered intravitreally, subconjunctivally and topically, if appropriate in combination by systemic
antibiotics (
vancomycin and
ceftazidime or
amikacin). If vision diminshes to mere light perception, performance of pars plana
vitrectomy is indicated. Treatment of acute postoperative endphthalmitis with delayed occurrence requires that the underlying complications (e.g.
suture dehiscences) are eliminated, and is carried out in accordance with the therapeutic principles for acute postoperative
endophthalmitis. In chronic postoperative
endophthalmitis, which is caused by bacteria,
antibiotics (
aminoglycosides or
vancomycin) are administered topically and intravitreally. If
antibiotic treatment is unsuccessful, a pars plana
vitrectomy must be performed including
posterior capsulotomy, appropriate with total removal of the capsular sac including the posterior chamber lens. In postoperative mycotic
endophthalmitis, antimycotics (
amphotericin B) are administered intravitreally. If findings are severe, a pars plana
vitrectomy must also be carried out with excision of
capsule, if necessary with removal of the posterior chamber lens. Antimycotics are applied topically to support treatment. Acute posttraumatic
endophthalmitis is treated by intravitreal
antibiotic administration (
vancomycin and
ceftazidime or
amikacin) in combination with pars plana
vitrectomy and removal of
foreign body. Treatment is supplemented by systemic, subconjunctival and topical
antibiotic administration. To reduce ocular destruction due to
inflammation, systemic and intravitreal administration of
steroids is recommended in all postoperative and posttraumatic
endophthalmitis conditions. Treatment of endogenous
endophthalmitis requires collaboration with an internist. Systemic
therapy with
antibiotics or mycotics is obligatory. In addition, broad-spectrum
antibiotics (
vancomycin or aminiglycosides) or antimycotics (
amphotericin B) are administered topically and intravitreally in these conditions. In severe
ocular infections, pars plana
vitrectomy is indicated.
PREVENTION: To reduce the risk of
infection, patients with infectious
eye diseases should be excluded from elective operations. Special attention must be paid to risk patients with defects of the immune system. Observation of hygienic regulations is obligatory. Prophylactic perioperative administration of
antibiotics has proved to be effective. Patients suffered from penetrating or perforating
injuries get systemic
antibiotics prophylactically. Qualified
follow-up care of the patient is necessary.
CONCLUSIONS: