The Endophthalmitis Vitrectomy Study (EVS) has recommended that intravitreal antibiotics should be the ‘‘standard of care’’ for acute endophthalmitis occurring after cataract surgery and that the benefit of early vitrectomy surgery is limited. However, with recent advances in vitrectomy surgery techniques, there has been an increased interest in performing early vitrectomy surgery to treat endophthalmitis in addition to intravitreal antibiotic therapy. Data from the EVS and more recently those of other studies from Australia and US have demonstrated that early vitrectomy surgery is not needed in all cases and that no visual benefit from vitrectomy surgery over intravitreal antibiotics injection was found in eyes with vision better than light perception. Whilst early vitrectomy surgery may have other potential benefits in patients with active endophthalmitis such as obtaining a larger vitreous sample and reduction of infection load, these should be weighted against the risk of iatrogenic retinal tears or intraocular haemorrhage in eyes with active intraocular inflammation. Furthermore, the logistics involved in setting up of emergency vitrectomy surgery may result in a significant delay in administering the intravitreal antibiotics which is counterintuitive and may deleteriously affect the visual outcome. Many of the organisms causing post operative endophthalmitis can double as fast as less than 25 minutes and thus treatmen t should be immediately initiated to preserve the vision In this presentation we will reflect on our experience in the management of post cataract surgery endophthalmitis and defend our opinion of why the EVS recommendations for the management of endophthalmitis remains valid.

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Ahmed Sallam