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Endogenous endophthalmitis
- 1. الرحيم الرحمن هللا بسم
- 2. By Prof. Dr. Fadel Abou shousha Alexandria University
- 4. Endogenous Endophthalmitis Fungi more than Bacteria Caused by
- 5. Management of Endogenous Fungal Endophthalmitis Specific fungal isolated Severity of infection Depends on
- 6. Once the diagnosis is suspected Other organs involvement must be sought
- 7. The use and type of systemic antifungal therapy will depend on The presence or absence of systemic fungal infection
- 8. In Candida Endophthalmitis • If Chorioretinal infilterates without vitrious involvement Systemic therapy alone
- 9. Systemic Amphotericin B • Initial test dose 1 mg in 20 ml 5% dextrose given IV over a period of 30 minutes
- 10. If no significant side effects • Treatment is initiated using 0.5 to 1 mg/kg/day in 500 ml dextrose over a period of 4 to 6 hours Hypotension Arrhythmia
- 11. Treatment is continued untill • Total dose 1000 to 1500 mg • The retinal lesions or Disappear Become small Fibrosed
- 12. In cases of amphotericin B toxicity Other less toxic systemic antifungal Ketoconazole Fluconazole 100-400 mg/day orally
- 13. In cases of vitreous involvement • Pars plana vitrectomy • Intravitreal injection of amphotericin B ( 5-10 ug )
- 14. Endogenous bacterial endophthalmitis Suspected in patients with intraocular inflammation of unknown etiology
- 15. Endogenous bacterial endophthalmitis It accounts for 8% of endophthalmitis
- 16. Causative organisms • Staph. Aureus • Strept. Species • E-coli
- 17. Sources of infection • Heart • GIT • Genitourinary tract
- 19. Clinical diagnosis Clinical signs Medical history
- 20. Extensive systemic evaluation Infectious disease specialist Possible sources of infection By Looking for
- 21. If the extraocular site of infection is known The organism responsible Is the same as that causing the eye infection
- 22. If no vitreous involvement Only systemic antibiotics
- 23. If there is vitreous involvement AC & Vit. taps Vitrectomy Intravitreal antibiotcs