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Infectious endophthalmitis is characterized by intraocular replication of microorganisms associated with inflammatory reaction
across a wide severity spectrum.
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Clinically, it is separated into exogenous or endogenous and acute or chronic endophthalmitis.
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Endophthalmitis is considered to be acute when the symptoms have started within 6 weeks of the initial event.
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Exogenous postoperative acute or chronic endophthalmitis are more common, due to the ever increasing number of intraocular
procedures world-wide.
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Acute postoperative endophthalmitis usually presents with sudden loss of visual acuity, increased ocular pain, red eye, swollen
lids, anterior chamber and vitreous reaction.
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Visual acuity after treatment may vary dramatically, with better outcomes commonly seen in eyes with culture-negative or coagulase-negative
gram-positive organisms without corneal infiltrates.
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Chronic postoperative endophthalmitis may present several weeks to years after surgery. The delayed more subtle signs include
granulomatous keratic precipitates, endocapsular hypopyon, and vitritis. The most common microorganisms involved are Propionibacterium acnes and coagulase-negative gram-positive Staphylococcus. Visual outcomes are generally better than acute cases, because these are lower virulence microorganisms.
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According to the Endophthalmitis Vitrectomy Study, if presenting visual acuity is light perception, immediate pars plana vitrectomy
should be done in addition to intravitreal antibiotics. If presenting VA is hand motions or better, no statistically significant
difference in outcomes have been found between vitrectomy and tap/biopsy.
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Regardless of presenting VA, media opacities clear faster with vitrectomy than with vitreous tap/biopsy.
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Techniques for surgical management of infectious endophthalmitis include 20-gauge pars plana core vitrectomy, 20-gauge total
vitrectomy, scleral buckling, intravitreal silicone oil, and endoscopy.
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In 25-gauge transconjunctival vitrectomy, the conjunctiva is less manipulated, and this may decrease patient discomfort during
surgery for an inflamed painful eye.
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Results comparable to those for other surgical options may be achieved with 25-gauge vitrectomy.
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Proper 25-gauge wound construction and care during surgery are important to maintain safe wound integrity.
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