PRACTICAL POINTS IN THE MANAGEMENT OF ENDOPHTHALMITIS
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This document provides guidelines for managing postoperative endophthalmitis. It recommends that if a patient has hand motion or better vision, an immediate tap or biopsy should be performed along with intravitreal antibiotic injection. For patients with light perception vision or less, an immediate vitrectomy with tap and biopsy is recommended. Intravitreal, subconjunctival, and topical fortified antibiotic therapies are outlined. Close follow up is important to monitor for signs of worsening infection requiring additional procedures.
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This document discusses endophthalmitis, including different types, epidemiology, clinical presentation, diagnosis, treatment, and outcomes. It provides details on the types of organisms commonly involved, methods of specimen collection for diagnosis, antibiotic susceptibility testing results, additional procedures based on visual acuity and clinical findings, and treatment approaches derived from the Endophthalmitis Vitrectomy Study including intravitreal antibiotics and corticosteroids without intravenous antibiotics or hospitalization in most cases.
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This document discusses endophthalmitis, including different types, incidence rates by surgical category, mean visual acuity outcomes after treatment, common intraocular organisms, antibiotic susceptibility, diagnosis, treatment approaches, and challenges. Some key points are:
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- Cataract surgery has the lowest incidence of endophthalmitis at 0.08%, while secondary IOL implantation has the highest at 0.37%.
- Gram positive bacteria like coagulase-negative staphylococci are the most common organisms found.
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3) The results show that punch trabeculectomy was more effective than medical treatment in lowering IOP, with a mean IOP reduction of over 50% achieved surgically. Surgical intervention was found to provide consistent and substantial IOP lowering compared to medical management.
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This is an audit I had done as Coordinator of acute pain service at Al Razi Hospital Kuwait. Through this I was able to draw attention to the rising rate of dislodgement and the technique of fixation was changed.
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1. The document discusses various ocular emergencies including traumatic injuries like hyphema, ruptured globe, and chemical burns as well as non-traumatic emergencies like acute angle closure glaucoma and orbital cellulitis.
2. Management strategies are provided for different conditions including irrigation for chemical burns, medications to lower IOP for glaucoma, and IV antibiotics for orbital cellulitis.
3. Immediate referral to an ophthalmologist is recommended for penetrating injuries, ruptured globe, retinal artery occlusion, and conditions requiring surgery.
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This document discusses the classification, incidence, clinical features, microbiology, prevention, and treatment of acute post-operative endophthalmitis. It classifies endophthalmitis based on onset and origin. Incidence is higher for post-traumatic compared to post-operative. Clinical features include decreasing vision, eye pain, redness, and photophobia. Treatment involves intravitreal antibiotics, vitrectomy, and adjunct topical/systemic antibiotics. The Endophthalmitis Vitrectomy Study showed vitrectomy benefits patients with light perception vision. Intravitreal and intravenous antibiotics are also recommended.
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2. The Endophthalmitis Vitrectomy Study showed that for acute post-operative endophthalmitis presenting with light perception vision or worse, immediate vitrectomy provided significant benefits over antibiotics alone. For better vision, vitreous tap with intravitreal antibiotics was equally effective.
3. Traumatic and chronic endophthalmitis often require vitrectomy due to severity of infection and inflammation, and difficulty sterilizing the vitreous cavity with antibiotics alone. Vitrectomy allows removal of infected material
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Similar to PRACTICAL POINTS IN THE MANAGEMENT OF ENDOPHTHALMITIS
Endophthalmitis management
This document discusses the classification, incidence, clinical features, microbiology, prevention, and treatment of acute post-operative endophthalmitis. It classifies endophthalmitis based on onset and origin. Incidence is higher for post-traumatic compared to post-operative. Clinical features include decreasing vision, eye pain, redness, and photophobia. Treatment involves intravitreal antibiotics, vitrectomy, and adjunct topical/systemic antibiotics. The Endophthalmitis Vitrectomy Study showed vitrectomy benefits patients with light perception vision. Intravitreal and intravenous antibiotics are also recommended.
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PRACTICAL POINTS IN THE MANAGEMENT OF ENDOPHTHALMITIS
- 1. الرحيم الرحمن هللا بسم
- 4. Management of Postoperative Endophthalmitis If you suspect endophthalmitis Do not hesitate Start Treatment immediately
- 5. If hand motion or better vision Immediate Tap or biopsy Injection of antibiotics
- 6. Patients with LP vision Immediate vitrectomy Tap Biopsy No PVD PVD Removal of 50% of the vit. gel Removal of more than 50 %
- 7. Intravitreal Antibiotics • 0.1 ml containing 1 mg Vancomycin • 0.1 ml containing 2.25 mg Ceftazidime With separate syringe and needle
- 8. Subconjunctival Injections • 0.5 ml containing 25 mg Vancomycin • 0.5 ml containing 100 mg Ceftazidime • 0.25 ml containing 6 mg Dexamethasone
- 9. Topical Antibiotics (fortified) • Vancomycin 50 mg/ml Alternating with either • Ceftazidime 50 mg/ml or • Amikacin 20 mg/ml
- 10. The patient should also be treated with • Pridnisolone acitate drops 1% every hour • Atropine sulphate twice daily • Pridnisolone orally 30 mg twice daily for 10 days
- 11. Close follow up If on the second postoperative day No Improvement Persistant Pain Hypopion Clouding of the media Additional Procedure
- 12. If the initial procedure was • Vitrectomy • Intravitreal antibiotics • Gram stain & Culture Vit Tap or Biopsy
- 13. If the initial Procedure was Vitrectomy AC TAP Vit Tap Gram stain & Culture Intravitereal injection of antibiotics
- 14. EVS Provides two conclusions • LP vision Immediate vitrectomy • Systemic antibiotics No benefit