A lecture by Prof Fadel Abou Shousha about Ticks and tricks in endophthalmitis management

1. ‫الرحيم‬ ‫الرحمن‬ ‫هللا‬ ‫بسم‬

2. PRACTICAL POINTS
IN
THE MANAGEMENT
OF
ENDOPHTHALMITIS

3. PROF. DR.
FADELABOUSHOUSHA
ALEXANDRIA UNIVERSITY
EGYPT

4. Management of Postoperative
Endophthalmitis
If you suspect endophthalmitis
 Do not hesitate
 Start Treatment immediately

5. If hand motion or better vision
Immediate Tap or biopsy
Injection of antibiotics

6. Patients with LP vision
Immediate vitrectomy Tap
Biopsy
No PVD
PVD
Removal of 50% of the vit. gel
Removal of more than 50 %

7. Intravitreal Antibiotics
• 0.1 ml containing 1 mg Vancomycin
• 0.1 ml containing 2.25 mg Ceftazidime
With separate syringe and needle

8. Subconjunctival Injections
• 0.5 ml containing 25 mg Vancomycin
• 0.5 ml containing 100 mg Ceftazidime
• 0.25 ml containing 6 mg Dexamethasone

9. Topical Antibiotics
(fortified)
• Vancomycin 50 mg/ml
Alternating with either
• Ceftazidime 50 mg/ml
or
• Amikacin 20 mg/ml

10. The patient should also be treated with
• Pridnisolone acitate drops 1% every hour
• Atropine sulphate twice daily
• Pridnisolone orally 30 mg twice daily for
10 days

11. Close follow up
If on the second postoperative day
No Improvement
Persistant Pain
Hypopion
Clouding of the media
Additional Procedure

12. If the initial procedure was
• Vitrectomy
• Intravitreal antibiotics
• Gram stain & Culture
Vit Tap or Biopsy

13. If the initial Procedure was
Vitrectomy
AC TAP Vit Tap
Gram stain & Culture
Intravitereal injection of
antibiotics

14. EVS
Provides two conclusions
• LP vision Immediate vitrectomy
• Systemic antibiotics No benefit