Vitrectomy in the management of endophthalmitis

Four cases of endophthalmitis were managed with pars plana vitrectomy and intravitreal antibiotics. All four cases made a good structural recovery, but the only cases which regained good vision were the two which had vitrectomy within three days of the first signs of endophthalmitis. The vitreous aspirate in all four cases showed polymorphonuclear leukocytes, but in only one case were organisms cultured. Vitrectomy is a means of removing the bulk of the infected material, of allowing dispersion of intra-ocular antibiotic, of removing membranes which may lead to later traction detachment of the ciliary body or retina, and of clearing the visual pathway. Microbiological diagnosis is best made by culture of vitreous aspirate. Retinal function is affected early in the course of the inflammatory process. Vitrectomy is recommended as the emergency primary treatment of acute endophthalmitis.