Post-Operative Endophthalmitis

Most cases are due to Gram positive micro-organisms

• Coagulase-negative Staphylococci (eg. S. epidermidis)
• Staphylococcus aureus
• Streptococci

Clinical features

• Typically 3-10 days post-operatively
• Low-grade anterior chamber inflammation
• Granulomatous KPs
• Vitritis
• Hypopyon (uncommon)

Differentiate from toxic anterior segment syndrome

• A marked, rapid onset anterior inflammatory response due to noninfectious substances entering the eye during surgery
• Minimal pain or redness
• Diffuse, limbus-to-limbus oedema
• Lack of vitritis
• Highly steroid responsive

Intravitreal therapy

• First-line is vancomycin (1 mg in 0.1ml)
• Typically given with ceftazidime (2 mg in 0.1ml) or amikacin if penicillin allergic (0.4mg in 0.1ml) for Gram negative coverage
• Gentamicin (200 micrograms in 0.1ml) is not routinely used due to retinal toxicity
• Amphoteracin if fungus suspected (5 micrograms in 0.1ml)

Other treatment

• Intensive topical antibiotics
• Systemic antibiotics and steroids are controversial
• Vitrectomy if presenting VA is PL or less

Chronic postoperative endophthalmitis

• Associated with Propionibacterium acnes (63%), also

  • Staph epidermidis (esp incompletely treated)
  • Candida parapsilosis
  • Corynebacterium species

• Develops >6 weeks post-op

• Responds to steroids but then recurs when they are stopped

• Posterior capsular plaque

• Requires culture and intravitreal antibiotics +/- vitrectomy +/- removal of lens-bag complex