Postoperative Endophthalmitis

Postoperative endophthalmitis remains a serious clinical problem in ophthalmology, with an incidence of approximately 0.5%. Prognosis is largely determined by the virulence of the offending organism. The Endophthalmitis Vitrectomy Study (EVS) was a prospective, randomized trial comparing various diagnostic and treatment modalities in cases of endophthalmitis that followed cataract surgery. The EVS found that vitrectomy was only beneficial for patients presenting with very poor visual acuity and that intravenous antibiotic treatments had no additional benefit, compared with intravitreal antibiotic therapy alone. However, weaknesses of the EVS leave these conclusions open to modification in the future. Preoperative application of povidone-iodine preparation to the skin and conjunctiva is the only proven endophthalmitis prophylaxis. Endophthalmitis may be chronic and may follow glaucoma surgery and intravitreal injection of gas and drugs. The EVS did not study these issues, although they are associated with specific features that may require alterations in patient management.