Empirical triple intravitreal antibiotics and core vitrectomy for acute postcataract infective endophthalmitis: Case series of three clusters with microbiological analysis
Ashish Lall, Taraprasad Das, Deepa Gupta, Shagun Sood, Neelam SapraAbstract:
PURPOSE:
The purpose of the study was to propose an alternative approach with triple antibiotics for treating cluster outbreaks of acute infective postcataract endophthalmitis.
DESIGN:
Retrospective interventional case series.
METHODS:
Eleven patients from three clusters of acute endophthalmitis after cataract surgery were treated with pars plana vitrectomy and three simultaneous intravitreal antibiotics: Vancomycin, Colistin, and Imipenem. Vitreous samples were sent for microbiology workup. Cluster infection was defined as two or more cases of endophthalmitis occurring in the same operative setting.
RESULTS:
All 11 patients (six male and five female) developed acute endophthalmitis within 2–4 days of phacoemulsification and intraocular lens (IOL) implantation. Presenting vision was counting fingers close to the face or light perception, and one had a 360° corneal ring infiltrate. Sensitivity report after 48 h in the first cluster showed
CONCLUSION:
Triple intravitreal antibiotics and vitrectomy may be advantageous in acute postcataract endophthalmitis, especially in cluster infections where multidrug resistance is likely, and sensitivity results take 48 h. Revising the two-drug protocol may improve outcomes in such time-critical scenarios.