First Author: C.Nakhwa INDIA
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Post operative endophthalmitis can be a devastating sight threatening complication.The anatomic and visual outcomes depend on the virulence of the organism and the timing of vitreoretinal surgery. The management of endophthalmits has to be prompt with an eagle eye on recurrent infection. Current tools of vitreoretinal surgery can help in the management of dificult cases of endophthalmitis with good chances of globe salvage and hope of regaining useful vision.
A 78 year old gentleman with history of sudden painful loss of vision (PL) in the right eye. He had undergone scleral buckling for RD and a SFIOL 10 years back. On examination the eye had dense exudates filling the AC with shallowing. The vitreous was full of dense infective exudates
The gentleman underwent an emergency vitrectomy with removal of exudates and injection of silicone oil. The vitreous sample was sent for Microbiological testing and PCR. Intravitreal vancomycin + ceftazidime were given. Oral ciprofloxacin was given for 5 days.
Microbiological tests showed gram negative bacilli which were sensitive to ceftazidime among other drugs. The patient was started on topical antibiotics and steroids. Intracameral antibiotics (ceftazidime 2.5mg) were repeated after 48 hours and subsequently as dictated by his clinical response. The anterior segment exudates cleared and the corneal clarity improved in 5 days. There was a dense exudative patch in the macular area which gradually contracted and reduced in size.The patient regained a vision of 3 metres, without a recurrence of infection on last followup which was six months from the day of surgery.
Delayed post operative endophthalmitis, post SFIOL is a known complication. Although P acnes and fungi are the common organisms in this region, gram negative bacilli are not very uncommon.The aim of surgery was to reduce the infective load and start appropriate antibacterial therapy, which was done. Timely surgical intervention can prevent sight threatening complications like hypotony, pthisis bulbi, retinal detachment etc.