Endophthalmitis: classification and current management

Abstract

Endophthalmitis remains an important cause of visual morbidity, even with appropriate and prompt treatment. Infectious endophthalmitis may be categorized by the cause of the infection and the characteristic timing of clinical symptoms and signs. The differential diagnosis includes noninfectious inflammation, such as toxic anterior segment syndrome, as well as pseudohypopyon composed of triamcinolone acetonide or dehemoglobinized intraocular hemorrhage. Two relatively newly appreciated categories of endophthalmitis that are becoming more prevalent are endophthalmitis associated with microbial keratitis and endophthalmitis following intravitreal injection. The Endophthalmitis Vitrectomy Study provides useful guidelines for the management of endophthalmitis. Prompt administration of antimicrobials is usually associated with better visual outcome making early diagnosis important. Advances in the management and prevention of endophthalmitis will probably come from improved antibiotic coverage, more effective removal of infected tissue, more rapid diagnosis and improved prevention strategies. The ultimate goal is improved visual results.

Keywords::

• endophthalmitis
• Endophthalmitis Vitrectomy Study
• intravitreal injection
• microbial keratitis
• toxic anterior segment syndrome

Acknowledgements

Supported in part by NIH center grant P30-EY014801, and by an unrestricted grant to the University of Miami from Research to Prevent Blindness, NY, USA.

Stephen G Schwartz, MD, has received research funding from Genentech and has served as a consultant to Novartis. Harry W Flynn Jr, MD, has served as a consultant to Alcon, Eli Lilly, Genentech, Novartis, Optimedica, and Pfizer. Ingrid U Scott has served as a consultant to Eli Lilly, Genentech, OSI/Eyetech and Pfizer, as well as on the speaker’s bureau of Eli Lilly, OSI/Eyetech, Novartis and Pfizer.

Notes

PPV: Pars plana vitrectomy.

PPV: Pars plana vitrectomy; TSV: Transconjunctival standard vitrectomy.