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Postoperative Endophthalmitis

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Albert and Jakobiec's Principles and Practice of Ophthalmology

Abstract

Postoperative endophthalmitis is a rare but potentially devastating infectious complication after ophthalmic surgery. The most common signs/symptoms include decreased visual acuity, conjunctival injection, hypopyon, and ocular pain. Other findings included vitritis, retinitis, and periphlebitis. Chronic postoperative endophthalmitis may present with insidious inflammation and possibly a posterior capsule plaque in pseudophakic patients. The most common organisms implicated in postoperative endophthalmitis are Gram-positive bacteria (73–85%), followed by Gram-negative bacteria (10–16%), and fungal organisms (5–16%). Postoperative noninfectious endophthalmitis may present similarly and should be considered on the differential, though patients will typically have less severe pain, inflammation confined to the anterior segment, and a more rapid onset of symptoms 12–24 h after surgery. Management of infectious endophthalmitis starts with obtaining culture samples from the vitreous; patients are routinely treated with vitreous tap or pars plana vitrectomy, along with broad-spectrum intravitreal antimicrobials. Additional therapies can include systemic antimicrobials and/or intravitreal corticosteroids. If culture results are positive for a specific organism, antimicrobial therapy can then be tailored to the specific susceptibilities of that organism. Unfortunately, despite prompt and appropriate therapy, visual outcomes may be poor, especially when more virulent strains of bacteria are responsible for the infection.

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Author information

Authors and Affiliations

  1. Mid Atlantic Retina/Retina Service, Wills Eye Hospital, Philadelphia, PA, USA

    Ajay E. Kuriyan

  2. Elmhurst, IL, USA

    Rehan M. Hussain

  3. Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA

    Harry W. Flynn

Authors
  1. Ajay E. Kuriyan
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  2. Rehan M. Hussain
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  3. Harry W. Flynn
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Corresponding author

Correspondence to Harry W. Flynn .

Editor information

Editors and Affiliations

  1. Casey Eye Institute, Oregon Health & Science, Portland, OR, USA

    Daniel M. Albert

  2. Department of Ophthalmology, Massachusetts Eye and Ear, Massachusetts General Hospital, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Joan W. Miller

  3. Department of Ophthalmology, University of Illinois College of Medicine, University of Illinois at Chicago, Chicago, IL, USA

    Dimitri T. Azar

  4. Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA

    Lucy H. Young

Section Editor information

  1. Massachusetts Eye and Ear, Boston, USA

    Dean Eliott

  2. Massachusetts Eye and Ear, Boston, USA

    Demetrios Vavvas

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Kuriyan, A.E., Hussain, R.M., Flynn, H.W. (2022). Postoperative Endophthalmitis. In: Albert, D.M., Miller, J.W., Azar, D.T., Young, L.H. (eds) Albert and Jakobiec's Principles and Practice of Ophthalmology. Springer, Cham. https://doi.org/10.1007/978-3-030-42634-7_98

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