INFECTIVE ENDOPHTHALMITIS FOLLOWING VITREORETINAL SURGERY

Eleven cases of endophthalmitis occurring after vitreoretinal surgery are described. At Moorfields Hospital, London, from 1986 to 1990 the i ncidence of endophthalmitis after explant surgery with or without drai n was 0.19% and after vitrectomy was 0.15%. We conclude that the parit y may be due to the intraocular instrumentation of most conventional r etinal detachment repair procedures. The best indicator of poor progno sis was speed of onset of symptoms, those with rapid evolution having the worst outcome; 2 of these cases were enucleated. Those presenting at 2-3 days had the best outcome, consistent with infection due to a l ess virulent organism. Delays in diagnosis were in part due to the pos terior location of signs of infection. Potential risk factors amenable to prophylactic strategy were identified in 10 of the 11 patients. Su pplementary prophylaxis using ciprofloxacin or imipenem is proposed fo r cases with an identifiable risk factor. After systemic administratio n these antibiotics achieve vitreous levels that exceed the MIC90 of t he commonest causative pathogens.