Good Hope, Heartlands, and Solihull Eye Clinics

Endophthalmitis

David Kinshuck

 

Endogenous endophthalmitis

  • sick patients on ward
  • bacterial, fungal, fungal endogenous
  • sick patient on itu with lots of tubes or iv drug user
  • one third candida, candida the most by far, tropicalis
    • Candida string of pearls, puff balls, whit round retinal lesions, blood culture MUST be done, and vitreous tap may be
    • Systemic treatment ESSENTIAL and inatravitreal treatment and vitrectomy.
    • Voriconazole, oral, at least ofr a month, inatravitreal amphotericin, and treat vitritis
    • half do badly
  • aspergillus ..rare, really sick patients
  • Bacterial uncommon, misdiagnosed, quarter bilateral, sick septicaemic, with other problems, diabetes common, renal failure etc, hiV,
  • Staph aureaus, , viridans, nocardia, klebsiealla.....from south east Asia.  40% will have endocarditis, transoesophageal  echo, liver abscess, needs usg liver, look for cellulitis, max fax look at teeth, Ear, etc
  • Systemic treatment vancomycin and ceftazidime or cipro
  • Must be source outside eye bacillus iv drugs, llood urine other sites culture, csf,
  • ?vitreous tap ....not if organism known

Post-vitrectomy endophthalmitis

  • Decreased vision, pain,apd, injection, chemosis, hypopyon
  • .05-0.3 % after phaco
  • 72% gm pos staph epidermididis
  • 50% within a week of surgery
  • Treat in casualty room
    • Vancomycin and ceftazidime gm +-respectively
    • culture rate higher theatre...BUT
    • best results were those treated <1 hour ....all improved
    • if delay > 10 hours... 50% imporved
    • so a vitrectomy in theatre increases culture rate, but the delay getting to theatre causes much worse results; best results are no vitrectomy, treating in emergency room
    • vitreous tap with 23g needle, if does not work 21g
    • must culture

Injection endophthalmitis, prevention