From the Guidelines
Endophthalmitis is a serious intraocular infection that requires immediate treatment with intravitreal antifungal agents, such as amphotericin B 5-10 μg/0.1 mL or voriconazole 100 μg/0.1 mL, to prevent vision loss. The diagnosis of endophthalmitis involves clinical examination, ultrasound, and vitreous tap for culture to determine the causative organism and guide treatment. The condition can be classified as exogenous (following surgery, trauma, or intravitreal injections) or endogenous (from bloodstream infection) 1.
Key Principles of Treatment
- Achieving adequate concentrations of antifungal agents in the infected area of the eye is crucial for success 1.
- Systemic antifungal agents, such as fluconazole or voriconazole, are often used in conjunction with intravitreal injections to treat candidemia and other organ involvement 1.
- Vitrectomy surgery is indicated for severe cases, particularly those with visual acuity of light perception or worse, to remove the vitreous and decrease the risk of retinal detachment 1.
Antifungal Agents
- Amphotericin B deoxycholate and voriconazole are commonly used for intravitreal injections to treat fungal endophthalmitis 1.
- Fluconazole and voriconazole are often used systemically to treat candidemia and other organ involvement, but their penetration into the vitreous is variable 1.
- Echinocandins have poor penetration into the vitreous and are not recommended as monotherapy for Candida endophthalmitis 1.
Management of Vitritis
- Intravitreal injection of antifungal agents, such as amphotericin B or voriconazole, is recommended to achieve high drug concentrations in the posterior chamber 1.
- Pars plana vitrectomy may be considered to remove the vitreous and decrease the risk of retinal detachment, and to provide material for culture to guide treatment 1.
- Close cooperation between ophthalmologists and infectious diseases specialists is necessary to manage Candida endophthalmitis with vitritis effectively 1.
From the Research
Diagnosis of Endophthalmitis
- Endophthalmitis is a serious, potentially vision-threatening condition that can present in various settings, including postoperative, post-injection, trauma, and systemic infection 2
- Prompt recognition and treatment are key in maximizing outcomes 2
- Diagnosis is typically made based on clinical presentation, including symptoms such as eye pain and blurred vision, and vitreous sampling to identify the causative organism 3, 4
Treatment of Endophthalmitis
- Treatment principles differ depending on the clinical circumstances, such as the virulence of the organisms encountered 2
- Postoperative endophthalmitis after cataract surgery is the most common presentation, and prompt intravitreal antibiotic administration after vitreous sampling is recommended, with consideration for pars plana vitrectomy in severe cases 2
- Immediate vitrectomy with intravitreal injection of antibiotics can be an effective approach for the treatment of acute endophthalmitis following intravitreal injections 4
- Combination therapy with intravitreal amphotericin B and voriconazole may be effective in treating filamentous fungal endophthalmitis 5
- Intravitreal injection of antibiotics, such as vancomycin and ceftazidime, is a common treatment approach for bacterial endophthalmitis 6
Specific Treatment Approaches
- For post-injection endophthalmitis, immediate vitrectomy with intravitreal injection of antibiotics can result in recovery of vision 4
- For fungal endophthalmitis, combination therapy with intravitreal amphotericin B and voriconazole may be effective, and pars plana vitrectomy may be necessary 3, 5
- For bacterial endophthalmitis, intravitreal injection of antibiotics, such as vancomycin and ceftazidime, is a common treatment approach 6