Intravitreal Antibiotic Requirements in Medically Managed Endophthalmitis: A Retrospective Analysis
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Yes
Purpose
To assess the average number of intravitreal antibiotics (IVTA) required for medically managed endophthalmitis.
Methods
Endophthalmitis cases from a single center over one year were analyzed. Cases unable to undergo early trans pars plana vitrectomy (TPPV) were treated conservatively with repeated IVTA at intervals guided by clinical response. Data included demographics, risk factors, visual acuities, endophthalmitis type, microorganism, and the total number of IVTA administered.
Results
Eighteen eyes from 19 patients (mean age 65.8 ± 9.7 years) were analyzed. Endogenous (55.6%), fungal (5.5%), post-surgical (16.7%), and post-IVT (22.2%) endophthalmitis cases were identified. Mean visual acuity was 1.96 ± 1.30 at baseline and 2.05 ± 1.56 at follow-up (mean duration 54 ± 45 days). The average number of IVTA injections in conservatively managed cases was 6.3 (median 5; range 2–15). The total IVTA injections required were not significantly correlated with choroidal abscess or panophthalmitis, though panophthalmitis cases tended to require more injections. No rebound worsening occurred following IVTA cessation, and no cases required evisceration. Intravitreal Ceftazidime and Vancomycin were most frequently used, with 48-hour dosing intervals being common. Conservatively treated cases required significantly more injections than early vitrectomy cases (1.9 injections, p < 0.05).
Conclusion
Medical management with repeated IVTA is effective but requires significantly more injections than early vitrectomy (6.3 vs. 1.9). Clinical response should guide treatment, especially for severe presentations like panophthalmitis. Further research is needed to develop objective biomarkers for treatment guidance.
Conflict of interest
No
1
Last name
LIM
Initials of first name(s)
J
Department
Ocular Inflammation and Immunology Department, Surgical Retina Department
City
Singapore
Country
Singapore
2
Last name
Chan
Initials of first name(s)
SYA
Department
Ocular Inflammation and Immunology Department
City
Singapore
Country
Singapore
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