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Endophthalmitis: controlling infection before and after cataract surgery.

Niyadurupola N, Astbury N - Community Eye Health (2008)

View Article: PubMed Central - HTML - PubMed

Affiliation: Specialist Registrar in Ophthalmology, Department of Ophthalmology, Norfolk and Norwich University Hospital NHS Trust, Colney Lane, Norwich NR4 7UY, UK. Email: nuwan.niya@doctors.org.uk.

ABSTRACT

Multiple factors can lead to endophthalmitis. The source of the bacteria is considered to be from the patient's own ocular surface or adnexa. For this reason, simple measures in the preparation of the patient have a dramatic effect on the reduction of endophthalmitis rates, in particular the instillation of povidone-iodine and careful draping to isolate the lid and lashes. The use of antibiotics at the conclusion of surgery, especially intracameral or subconjunctival cefuroxime, is also recommended.

Instil povidone-iodine 5% eye drops prior to surgery.

Carefully drape the eyelid and lashes prior to surgery.

Use sterile gloves, gowns, and face masks.

Construct watertight incisions, preferably three-plane.

Manage complications (e.g. capsular rupture) effectively.

Acrylic optics are better than silicone.

Inject intracameral cefuroxime postoperatively (1 mg in 0.1 ml normal saline).

Inject intracameral cefuroxime postoperatively (1 mg in 0.1 ml normal saline).

Admit the patient, stop antibiotics, and prepare for theatre.

Perform a vitreous tap with or without capsulectomy.

Give an intravitreal injection of vancomycin 2 mg and cefuroxime (or ceftazidime) 2 mg (or 0.5 mg amikacin if the patient is allergic to penicillin).

Give a subconjunctival injection of vancomycin 50 mg and cefuroxime (or ceftazidime) 125 mg (or amikacin 50 mg if the patient is allergic to penicillin).

Send the vitreous sample for microscopy and culture.

Monitor the pain experienced by the patient. A reduction in pain suggests bacterial kill.

Start instilling vancomycin 5% and ceftazidime 5% eyedrops hourly.

If you cannot see the posterior segment, do an ultrasound B-scan, if this is available.

If there is no improvement within 24 hours, consider repeating the vitreous sample and the antibiotic injections.

Consider topical or systemic steroids if you are confident the infection is under control (i.e. pain is diminishing, fibrin is contracting, hypopyon is decreasing).

Taper the treatment according to the patient's response and culture results.

Keep the patient informed of progress.

Keep the patient informed of progress.

Note: Vancomycin and cefuroxime (or ceftazidime) must not be mixed in the same syringe – draw up in separate syringes.

Reproduced by kind permission of The Royal College of Ophthalmologists

No MeSH data available.


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Endophthalmitis: controlling infection before and after cataract surgery.

Niyadurupola N, Astbury N - Community Eye Health (2008)

© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2377381&req=5

View Article: PubMed Central - HTML - PubMed

Affiliation: Specialist Registrar in Ophthalmology, Department of Ophthalmology, Norfolk and Norwich University Hospital NHS Trust, Colney Lane, Norwich NR4 7UY, UK. Email: nuwan.niya@doctors.org.uk.

ABSTRACT

Multiple factors can lead to endophthalmitis. The source of the bacteria is considered to be from the patient's own ocular surface or adnexa. For this reason, simple measures in the preparation of the patient have a dramatic effect on the reduction of endophthalmitis rates, in particular the instillation of povidone-iodine and careful draping to isolate the lid and lashes. The use of antibiotics at the conclusion of surgery, especially intracameral or subconjunctival cefuroxime, is also recommended.

Instil povidone-iodine 5% eye drops prior to surgery.

Carefully drape the eyelid and lashes prior to surgery.

Use sterile gloves, gowns, and face masks.

Construct watertight incisions, preferably three-plane.

Manage complications (e.g. capsular rupture) effectively.

Acrylic optics are better than silicone.

Inject intracameral cefuroxime postoperatively (1 mg in 0.1 ml normal saline).

Inject intracameral cefuroxime postoperatively (1 mg in 0.1 ml normal saline).

Admit the patient, stop antibiotics, and prepare for theatre.

Perform a vitreous tap with or without capsulectomy.

Give an intravitreal injection of vancomycin 2 mg and cefuroxime (or ceftazidime) 2 mg (or 0.5 mg amikacin if the patient is allergic to penicillin).

Give a subconjunctival injection of vancomycin 50 mg and cefuroxime (or ceftazidime) 125 mg (or amikacin 50 mg if the patient is allergic to penicillin).

Send the vitreous sample for microscopy and culture.

Monitor the pain experienced by the patient. A reduction in pain suggests bacterial kill.

Start instilling vancomycin 5% and ceftazidime 5% eyedrops hourly.

If you cannot see the posterior segment, do an ultrasound B-scan, if this is available.

If there is no improvement within 24 hours, consider repeating the vitreous sample and the antibiotic injections.

Consider topical or systemic steroids if you are confident the infection is under control (i.e. pain is diminishing, fibrin is contracting, hypopyon is decreasing).

Taper the treatment according to the patient's response and culture results.

Keep the patient informed of progress.

Keep the patient informed of progress.

Note: Vancomycin and cefuroxime (or ceftazidime) must not be mixed in the same syringe – draw up in separate syringes.

Reproduced by kind permission of The Royal College of Ophthalmologists

No MeSH data available.