The treatment of postoperative endophthalmitis. Results of differing approaches to treatment

The authors treated 26 patients with postoperative endophthalmitis over a 4-year period, between 1983 and 1986. Nineteen patients were culture-positive and seven were culture-negative. All patients received intravitreal antibiotics as part of their treatment regimen. Culture-negative patients generally responded well to a single intravitreal antibiotic injection. Five of seven (71.4%) culture-positive patients who were treated with a single intravitreal antibiotic injection and no vitrectomy suffered either a recurrence of their infection or did not respond to treatment. Four of five patients who received a vitrectomy in addition to a single intravitreal antibiotic injection were cured of their infections; the one patient who received repeated intravitreal antibiotic injections alone and all six patients who received repeated intravitreal antibiotic injections in combination with vitrectomy were cured of their infections. Although the intravitreal injection of antibiotics provides an extremely high initial level of antibiotics inside the eye, a single intravitreal antibiotic injection may only partially treat bacterial endophthalmitis. In culture-negative cases, a single intravitreal injection of antibiotics appears to be sufficient treatment. In culture-positive cases, a higher cure rate is achieved with an aggressive approach which includes the use of repeated intravitreal antibiotic injections and/or vitrectomy.