|
Establishing general conclusions from a
single case such as this one can lead to incorrect practice. Still,
this patient’s clinical course raises the possibility that
when significant retained lens material is present in endophthalmitis—whether
visualized by fundus exam or noted on ultrasound examination of
the eye—early intervention with pars plana vitrectomy, removal
of retained lens fragments, and intravitreal antibiotic injection
should be considered, even if the presenting visual acuity is
hand motions or better. As noted in the EVS and elsewhere, early
therapeutic vitrectomy might be considered for cases with progressive
inflammation despite initial antibiotic therapy and for cases
in which patients have not improved despite initial therapy (1-5).
The use of intravenous antibiotics in the
treatment of infectious endophthalmitis remains controversial. The
EVS reported that there was no difference in final visual acuity
or media clarity whether or not systemic antibiotics (ceftazidime
and amikacin) were used (3).
However, the spectrum of coverage, the intraocular penetration achieved
after intravenous administration of the selected antibiotics, and
the spectrum and susceptibilities of the microbiologic isolates
reported by that study (4)
may have led to this conclusion. Thus, the decision to use intravenous
antibiotics should be based on the clinical findings and the judgment
of the treating physician. |
