Page 117 - NAME OF CONDITION: REFRACTIVE ERRORS
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*Situation 2: At Super Specialty Facility in Metro location where higher-
end technology is available
a) Clinical Diagnosis:
The surgeon at the tertiary care center should elicit the history of the disease afresh to plug
the missing links if any, especially in endogenous endophthalmitis. Postoperative and
traumatic endophthalmitis history is generally straight forward. A detailed treatment
history and the culture results if any should be noted. In culture negative cases fresh
investigations should be initiated to rule out phacoanphylactic endophthalmitis or retained
intraocular foreign body.
b) Investigations:
Meticulous ultrasonogram of the eye may detect retained lens matter. Compuerised
tomography may detect occult intraocular foreign bodies in traumatic endophthalmitis.
Special investigations like polymerase chain reaction of the vitreous or aqueous samples
may be an useful additional diagnostic tool in culture negative cases. A repeat smear and
culture of ocular fluids is mandated. The commonly used stains and culture media are
mentioned below.
Presumed organisms Stain Media
Aerobic bacteria Gram Blood agar
Giemsa Chocolate agar
Thioglycolate broth
Anaerobic bacteria Gram Anaerobic blood agar
Thioglycolate broth
Fungi 10%KOH Blood agar
Gram Saboraud dextrose agar
Calcofluor white Brain heart infusion
c)Treatment:
The culture sensitivity results help in choosing appropriate antibiotics for treatment.
1.Vancomycin and ceftazidime with or without dexamethasone stand as the preferred
combinations of intravitreal drugs if no organisms are isolated.
2.A combination of vancomycin with amikacin is advocated as the empirical treatment in
traumatic endophthalmitis.
3.In Soil contaminated foreign body injuries where bacillus caerus is suspected,
combination of gentamicin with clindamicin in an option.
4. Pars plana vitrectomy remains the treatment of choice in severe endophthalmitis and in
cases where the disease progression is noted in spite of the initial antibiotic treatment.
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