Endophthalmitis update

Purpose. To review and update advances in the diagnosis, management, and results of post-operative and post-traumatic endophthalmitis. Methods. The current status of basic science research in endophthalmitis will be reviewed, along with current clinical treatments and results. Results. The post-operative national clinical trial, the Endophthalmitis Vitrectomy Study (EVS) has shown that employment of intravitreal antibiotics, combined with either a vitreous tap or vitrectomy, was equally effective, except in cases presenting with vision of light perception. Systemic antibiotic therapy did not effect final outcome. This post-operative data will be compared to data from post-traumatic infections, where differing organisms are encountered, often more virulent and associated with toxins. Prognostic factors including vision at presentation, associated ocular pathology, type and virulence of organism, timing of surgical intervention, and use of antibiotics will be discussed. Controversies including the specific type of intravitreal antibiotics employed, the type and usage of systemic antibiotics, and the use of corticosteroids will be discussed. Conclusions. Basic science advances in the understanding of the mechanisms of infection, combined with improved clinical data in the treatment of endophthalmitis, allow for continued improvements in the management of this devastating condition.