The treatment of endophthalmitis—still an exercise in frustration

Even though endophthalmitis is a rare complication of cataract surgery (recent studies report an incidence of 0.12% in the USA1 and 0.17% in Denmark2 ) its treatment continues to be a frustrating problem leading frequently to disastrous visual results. In this issue of the BJO (p 719) Okhraviet al assess the effect of a standard treatment protocol on the visual outcome of patients who have been diagnosed as having presumed bacterial endophthalmitis following intraocular surgery or penetrating ocular trauma. This protocol utilises early aggressive treatment with a standard regimen of high dose broad spectrum intraocular and systemic antibiotics. It also assesses the sensitivity of the organisms isolated to the specific antibiotics employed. In spite of aggressive and appropriate broad spectrum antibiotic therapy the final visual outcome was poor, with 55% of postsurgical and 40% of post-traumatic cases achieving a final visual acuity of 6/60 or less.

Why is the treatment of endophthalmitis still such an exercise in frustration? Are we somehow missing the point as clinicians, or is intraocular infection a problem in which a successful cure will always remain beyond our grasp? One difficulty is that …