Presented in ASCRS 2008

1. Abou Shousha Triple Procedure
in the Management of Endophthalmitis
After Cataract Extraction:
Eight-Year Experience
ASCRS 2008
Prof. Fadel AbouShousha
Mohamed Abou Shousha MD
Alexandria University

4. Abou Shousha Triple Procedure
(ATP)
Intravitreal
injection of
Antibiotics
(I.V)
Viscodissection
and Peeling of
AC membranes
(V.D.P)
Intracameral
injection of
Antibiotics
(I.C)

5. Patients with HM or better vision
Immediate Triple Procedure
without Vitrectomy
Tap &
Biopsy
+

6. Patients with PL
Immediate Triple Procedure
with Vitrectomy
Tap &
Biopsy
+

7. Viscodissection and Peeling of AC membranes
(V.D.P)

8. Viscodissection and Peeling of AC membranes
(V.D.P)

9. • Vancomycin 100 mg/ml
• Moxifloxacin 160 mg/ml
Intracameral Injection of Antibiotics
(I.C)

10. Intravitreal Injection
(I.V)
• 0.1 ml containing 1 mg Vancomycin
• 0.1 ml containing 0.4 mg
Dexamethasone
• 0.1 ml containing 2.25 mg Ceftazidime
or 0.4 mg Amikin

11. Subconjunctival Injections
• 0.5 ml containing 25 mg Vancomycin
• 0.5 ml containing 100 mg Ceftazidime
• 0.25 ml containing 6 mg Dexamethasone
Without mixing drugs

12. Topical Antibiotics
(fortified)
• Vancomycin 50 mg/ml
Alternating with either
• Ceftazidime 50 mg/ml
or
• Amikacin 20 mg/ml

13. The patient should also be treated with
• Pridnisolone acetate drops 1% every hour
• Atropine sulphate twice daily
• Pridnisolone orally 30 mg twice daily for
10 days

14. If No Improvement
• Vitreous and AC tap Reculture
• Triple Procedure with Vitrectomy
• Shifting to another group of antibiotic
Additional procedure

15. • 131 eyes
• Age ranging from 8 to 79
• Mean age was 43.5
• Only one case was bilateral.
Demography

17. 42
9 8
4
6
72
0
10
20
30
40
50
60
70
80
Coagulase –ve
Staphylococci
Staphylococci
Aureus
Streptococci P Acnes Pseudomonas Culture Negative
No of
Patients

18. Visual Acuity Outcomes 6 months postop
No.
of Eyes No PL
PL
HM-
1/60
1/60-
5/60
6/60-
6/24
6/18≤
0
1
2%
4
8%
3
6%
18
35%
25
49%
51
39%
Triple
Procedure
Presenting
with HM
3
5%
6
10%
5
8%
23
38%
21
34%
3
5%
61
40%
Triple
Procedure
with
Vitrectomy
presenting
PL
3
37.5%
1
13%
1
13%
1
13%
2
25%
0
8
Additional
after ATP
7
64%
2
18%
1
9%
1
9%
0
0
11
Add after
ATP+Vit
13
10%
10
7%
11
8%
28
21%
41
31%
28
21%
131
Early
Presentation
Late
Presentation
Poor Visual outcome

19. Conclusion
• Abou Shousha Triple Procedure may be
considered an effective modality of the
treatment of post-operative endophthalmitis
with or without Vitrectomy according to the
visual acuity of the patient on presentation.

20. Thank you