Treatment protocol for post operative endophthalmitis

Resumen o Introducción

Endophthalmitis is a devastating complication of ocular surgery and trauma, which may lead to total loss of vision and sometimes even the eyeball. Management 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 literature is 0.1% to 0.4%. Though no study is available, 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 poor therapeutic response. Another mode of treatment that has now become the standard treatment for endophthalmitis in developed countries is intravitreal injection of antimicrobials. Studies have proven this to be an effective, probably the only effective treatment available so far. In Pakistan this way treatment has not yet been widely practiced.

The authors have carried out a study on 56 eyes diagnosed as cases of endophthalmitis. 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 to publish the technique.

The aim of this booklet is to present in a simple way the 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.