Mild moderate corneal edema diffuse

366

CLINICAL SPOTLIGHT - RETINA

although currently many clinicians prefer oral�Gatifloxacin�or�Moxifloxacin.��
After intravitreal antibiotics, patient is monitored for 24-36 hours.

Table 2: Differences Between TASS and Infective Endophthalmitis

Cause	Noninfectious reaction to toxic agent present in: BSS solution Antibiotic injection Endotoxin Residue

Signs/ Symptoms *distinguishing feature	Blurry vision Pain: none, or mild to moderate Corneal edema: diffuse, limbus to limbus* Pupil: dilated, irregular, nonreactive* Increased IOP* Anterior chamber: mild to severe reaction�with�cells,�flare, hypopyon,�fibrin Signs and symptoms are limited to anterior chamber* Gram stain and culture negative Ultrasound is anechoic

COMMON INTRAVITREAL DRUGS USED IN ENDOPHTHALMITIS

The common intravitreal drugs and dilutions for constituting the intravitreal concentration in the management of endophthalmitis is outlined in (Table 3).

Intravitreal Antibiotics OR Topical + S/C + I/V Steroids
This can be treated as TASS with

MANAGEMENT

Topical	treatment

Tobramycin	1	hourly	along	with

cycloplegics in the form of Atropine every six hourly. The topical drug dosage is tailored according to response. Topical steroids are added 1-2 days later.

Intravenous� Ciprofloxacin� 200� mg�twice daily is required in very severe cases.


	VANCOMYCIN
(1 mg in 0.1 ml)				(400 microgm in 0.1 ml)

ml/10 mg in 0.2 ml
Add 10 ml				Take 0.2 ml
50 mg in 1.0 ml				Add 2.3 ml		10 mg in 2.5 ml
10 mg in 0.2 ml				Take 0.1 ml		0.4 mg in 0.1 ml
Take 0.2 ml

	�	�		• GENTAMYCIN
•	CEFTAZIDIME/CEFAZOLINE

				Take 0.1 ml		4 mg
Add 2.0 ml			500 mg in 2 ml	Add 1.9 ml
250 mg in 1.0 ml				Take 0.1 ml
				•�	Diluent�used�(Water�for�Injection/Ringer�
Make it to 1.0 ml				•�
				•�	All�preparations�done�by�Surgeon�himself,�
				•�	under strict aseptic conditions.
• DEXAMETHASONE					under strict aseptic conditions.
• DEXAMETHASONE

Dr. Lalit Verma

367

•

5% dextrose

0.5 mg in 0.1 ml

Take 0.1 ml

0.5 mg

Take 0.1 ml

0.005 mg

•

200 mg in 20 ml

10 mg in 1.0 ml

Take 1.0 ml

1.0 mg in 1.0 ml

50/100 micro

gm

However in situations where there is a partial response to intravitreal antibiotics with resolution of hypopyon but persisting AC reaction (3-4+), further intravitreal antibiotics are not preferred, conservative medical management is continued and patient is readied for surgical intervention.

In situations where there is no response to intravitreal antibiotics or in very severe infection, RADICAL pars plana vitrectomy with peeling of hyaloid and base dissection is required. There is no role for core vitrectomy in this situation.

CLINICAL SPOTLIGHT - RETINA

Figure 2C&2D: Treatment with intensive steroids, and DAY 2: BCVA 6/18, reaction significantly less, fundus details much clearer.

severe

endophthalmitis,

acne

and recurrent endophthalmitis.

This condition is extremely severe

be seen. Smears, cultures may help if

and intravitreal voriconazole (50-100

regard to preparation of Avastin is always

topical antibiotics are usually continued.

incidents of Cluster Endophthalmitis with

CHRONIC ENDOPHTHALMITIS

Prognosis

generally

intravitreal

antibiotic

injections

+

IOL

removal

during

vitrectomy