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R.J. Smiddy, W.E. Smiddy, B. Ba'ath, H.W. Flynn, Jr, T.G. Murray, W. Feuer; Endophthalmitis: Are Subconjunctival Antibiotics Necessary? . Invest. Ophthalmol. Vis. Sci. 2004;45(13):524.
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Purpose: To determine if the results for endophthalmitis treatment are afftected by subconjunctival antibiotic use when combined with standard procedures. Methods: A consecutive series with clinically apparent bacterial endophthalmitis and positive cultures was studied. Cases associated with cataract surgery, glaucoma filtering blebs, or trauma presenting with visual acuity(VA) of hand motions (HM) or better were included. Cases with positive cultures without symptoms, VA below hand motions, and fungal cases were excluded. Outcome measures included best and final corrected VA, reinjection of intravitreal antibiotics, subsequent surgery, and complications. Aubconjunctival antibiotic were usedat the discretion of the treating physician. Cases with less than 3 months follow–up were excluded from the study; however eyes with NLP or eye removal before 3 months were normalized to 3 months follow–up (1 patient with subjconctival injection). Results: There were 59 patients identified, of which 54 met the follow–up criteria. These were analyzed as two groups based on whether subconjunctival antibiotics were used (Group C, n=21) or not used (Group S, n=33). Median pretreatment acuity was HM in both groups. The percentage of male cases in the two groups was 33% and 52% respectively (p=0.26) and the median age in both groups was 74 years. Etiology, duration of symptoms, vitreous cultured organisms, and IOL type were similar. The percentage of cases with wound complications in the two groups was respectively, 52% and 64% (p=.57). Intravitreal and topical antibiotics and corticosteroids used were not significantly different in the two groups, except for topical ceftazadime was used less frequently in group C (43% v 82%, p=0.007). The median follow–up interval (mos) was 13 in both groups; range, 2 to 87 for group C and 3 to 63 for group S. The VA (C v S) was distributed as at least 20/50 (33% v 39%), 20/60–5/200 (29% v 39%), 4/200 to >HM ( 0% v 3%), or HM or less (38% v 18%) which was not significantly different (p=0.11). Reinjection rates were similar in the two groups. The reoperation rate was significantly higher in Group C (p=0.024), with cumulative rates of 50% and 20% respectively at 24 months follow–up. Conclusions: Though the possible influence of selection bias cannot be discounted in this retrospective study, these data suggest that subconjuntival antibiotics are not a necessary treatment in most cases of infectious endophthalmitis when standard tap/inject techniques and topical antibiotics are used.
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