Postoperative Endophthalmitis Follow-up
- Author: Hemang K Pandya, MD; Chief Editor: Hampton Roy, Sr, MD more...
Further Outpatient Care
Initially, administer topical therapy hourly and taper only after clinical improvement is seen.
Examine patients on a daily basis during the initial treatment period to ensure adequate sterilization of the vitreous cavity, to control intraocular inflammation, and to identify the need for additional intervention.
In the EVS, a total of 44 patients (10.5%) underwent an additional procedure during the first week after initial treatment, with 6 undergoing a procedure due to a complication of the disease or treatment and 38 due to worsening inflammation. Of the patients in the TAP group that underwent repeat intraocular cultures, 71% had persistent positive cultures, compared to 13% in the VIT group, suggesting that vitrectomy may be more effective in sterilization of the ocular contents.
The EVS also evaluated the need for additional procedures between 1 week and 1 year, the endpoint for follow-up care. A total of 26.9% of patients underwent a late additional procedure. The most common reasons for intervention included opacified posterior capsule (9.0%), retinal detachment (4.3%), recurrent endophthalmitis (3.3%), and glaucoma (2.6%).
The main complication associated with postoperative endophthalmitis is severe visual loss. This occurs most commonly in patients who develop infections from virulent organisms (non–coagulase-negative staphylococci, streptococci, and gram-negative organisms), receive delayed treatment, or have vision worse than hand motion at presentation.[1, 13, 20]
An important late complication of treatment of postoperative endophthalmitis remains retinal detachment. In a report from the EVS, retinal detachment can occur in 10% of patients after treatment. Possible factors involved include iatrogenic retinal tears at the time of vitreous tap, injection of antibiotics, vitrectomy, late tears associated with subtotal posterior vitrectomy, or just a consequence of the infection/inflammation and the secondary retinal necrosis. Prompt treatment of retinal detachment may result in good visual outcomes in select cases.
One of the most important factors related to good visual outcomes after postoperative endophthalmitis is prompt recognition and diagnosis. It is critically important to counsel patients to look for the early signs and symptoms of endophthalmitis (eg, pain, redness, decreased vision) and to contact the operating physician immediately if present. If diagnosed and treated promptly, most cases may result in acceptable visual outcomes.
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