ASSESSMENT OF A STANDARD TREATMENT PROTOCOL ON VISUAL OUTCOME FOLLOWING PRESUMED BACTERIAL ENDOPHTHALMITIS

Aims-The aim of this prospective study was, firstly, to judge the effe ct of early aggressive treatment with a standardised regimen of high d ose broad spectrum intraocular and systemic antibiotics on visual outc ome and, secondly, to assess the sensitivity of isolated organisms to the treatment regimen utilised. Methods-Thirty two consecutive patient s presenting with presumed bacterial endophthalmitis were treated and completed follow up. In every case, intraocular sampling was undertake n and treatment with intraocular vancomycin, amikacin, and systemic ci profloxacin was commenced immediately, followed by systemic steroids 1 day later. Results-In 69% of patients vision improved with 47% achiev ing a final visual acuity of 6/36 or better and 31% achieving 6/12 or better. Of the intraocular samples taken from post-surgical and posttr aumatic cases, 10/27 (37%) and 3/5 (60%) were culture positive, respec tively. All the bacteria isolated were sensitive to at least one of th e three antibiotics used. Conclusions-The study demonstrated that the combination of vancomycin, amikacin, and ciprofloxacin is adequate as a standard regimen for the treatment of most patients with suspected b acterial endophthalmitis. The prognosis for a good visual outcome, how ever, remains poor with 15/27 (55%) post-surgical and 2/5 (40%) post-t raumatic cases achieving a final acuity of 6/60 or less.