Approaches for managing treatment of patients with endophthalmitis

At Retina World Congress, Dr Harry W. Flynn presented a series of videos that illustrated vitrectomy techniques in endophthalmitis management cases. In the four cases he presented, Dr Flynn described a variety of endophthalmitis management options for retinal surgeons.

Video transcript

Thank you. I was part of a symposium on uveitis, and I was specifically talking about endophthalmitis management approaches. My focus was on vitrectomy techniques in the management of endophthalmitis cases.

I started out with a case of endogenous endophthalmitis caused by Candida albicans. The traditional way of handling these cases is to perform a pars plana vitrectomy. But many of these eyes are prone to retinal detachment because of vitreoretinal traction. And because of large lesions that have organisms growing through the choroid into the retina and into the vitreous, these lesions are often highly elevated.

In a video, I showed a technique of laser treatment to surround the lesions first, and then to actually obliterate the lesion with direct focal laser. We still use intravitreal and systemic antifungals as part of the treatment.

My second case was a bleb-associated endophthalmitis, and I show 27-gauge vitrectomy techniques to enter the eye, especially when these eyes are very congested, and to remove the vitreous and allow injection of intravitreal antibiotics. It is important to avoid de-bleeding the bleb because these blebs are highly necrotic. And if you do so, the debris mot will leave a large hole in the sclera often with leakage…very difficult to close. So we just use subconjunctival antibiotics in these cases, which are usually adequate.

My third video was on a combined approach to keratitis-associated endophthalmitis. These cases are particularly tough because the cornea is opaque. There is no view of fundus details. So I showed a combined approach with 25-gauge surgery, a corneal transplant, removal of the intraocular lens, performance of a pars plana vitrectomy, and placement of fresh corneal tissue graft in place when finally with injection of individual antibiotics.

My last case was a suture removal-related endophthalmitis. These cases occur rarely, but they do occur when people forget to use povidone iodine on the ocular surface. And these are often caused by Streptococcus, which is a very virulent organism, and it causes poor outcomes. I showed a technique of using 27-gauge vitrectomy in the anterior chamber to remove the fibrin clot, followed by a pars plana vitrectomy. again using 27-gauge techniques. The pictures that I showed were courtesy of David Jacobs, one of my former fellows who allowed me to use his slides.

In summary, I used my presentation as a way to present vitrectomy approaches for endophthalmitis in these very difficult and challenging cases.