Visual prognosis in bacterial endophthalmitis treated with intravitreal antibiotics

Eleven of 16 cases of human culture-proved endophthalmitis have been successfully treated with the intravitreal administration of 400 micrograms of gentamicin sulfate and 360 micrograms of dexamethasone with concomitant use of systemic antibiotics and prednisone. Seven of the 16 eyes (44%) had final visual acuity of 20/400 or better. Four additional eyes had residual useful vision after treatment. The visual prognosis in these cases is directly related to the exotoxin and proteolytic enzyme activity of the organisms. Delay of more than 36 hours between onset of symptoms and intravitreal treatment adversely affects the visual outcome. If a highly virulent organism has been isolated or if treatment has been delayed, vitrectomy to treat acute endophthalmitis is indicated. The comparatively high rate of recovery in this series is probably related to the high dose of intravitreal gentamicin utilized and the concomitant intraocular use of dexamethasone.