Intravitreal antibiotics vs Vitrectomy for endophthalmitis

Intravitreal antibiotics vs Vitrectomy for endophthalmitis

In the era of vitrectomy, is there still a role for antibiotics ?

But, if we lack facilities and experts, are antibiotics sufficient to treat this devastating disease?

All of this and more will be discussed in our debate - mark your calendars and come!

Parsplana vitrectomy for endophthalmitis 

Dr. Omar Yaseer (born in 1992) is a Syrian ophthalmologist. He graduated in 2016 with a Doctor of Medicine degree from Tishreen University, Latakia, Syria. He obtained three certificates from the International Council of Ophthalmology (ICO) in 2019 and 2020 and became a member of The Royal College of Surgeons of Edinburgh MRCSEd(Ophth). He completed a postgraduate training program in ophthalmology at Tishreen university Hospital, Latakia, Syria in 2020. and attained The Syrian Board in 2022.

Intravitreal antibiotics for endophthalmitis

Dr. Marwa Baba (Augest1994) is a Syrian ophthalmologist, she graduated with a Doctor of Medicine degree from Aleppo University in Syria in 2018, and obtained Syrian Board in ophthalmology in 2022, she is working in Marashi Eye Clinic right now. with one publication and is the Translator of the Clinical guidelines for approaching and managing common retinal diseases written by Dr. Ameen Marashi and assisted Dr. Ameen Marashi with his other publications.

The verdict by Ameen Marashi in the rational of Antibiotic VS Vitrectomy for endophthalmitis

Dr.Ameen Marashi (born December 9, 1983) is a Syrian ophthalmologist and retina specialist.He has published a number of books and research articles in the field of retina and is the Al-Marashi Clinics Group owner.He graduated with a Diploma degree in Medicine from the Chuvash State University Institute of Medicine in 2008, and a certificate from the International Council of Ophthalmology in 2013, and completed a specialization in ophthalmology in Tartous Hospitals in 2009, and from 2010 until 2013 in Aleppo, and obtained a certificate Syrian Board 2016.

Meeting Summary 

For the vitrectomy round: 

Advances in surgical techniques have meant that PPV, in the context of endophthalmitis, frequently involves induction of posterior vitreous detachment (PVD) and a greater than 50% clearance of vitreous. There is, therefore, greater reduction of bacterial load and greater clearance of toxins and inflammatory debris.vMicro-Incision Vitrectomy Surgery results in reduced intra-operative trauma and fewer complications, reduced post-operative inflammation and faster post-operative visual recovery. Immediate vitrectomy is recommended for the most severe infections especially when an experienced vitreoretinal surgeon is available.

For the intravitreal antibiotic round: 

In an ideal world, we would have a Vitreoretinal surgeon and fully staffed operating room immediately available, but this is not always the case. When endophthalmitis is diagnosed, a timer should be started for the administration of intravitreal antibiotics in the most sterile setting available, regardless of the presence of microbiological facilities.

For Verdict round:

An ophthalmologist should treat infectious endophthalmitis as an emergent situation right after diagnosing it with clinical examination and B-scan. PPV with obtaining an adequate vitreous sample for culturing and injecting intravitreal antibiotics should be considered as first-line therapy as soon as infectious endophthalmitis is diagnosed, especially when acute post-cataract infectious endophthalmitis presents with severe clinical presentations and poor vision. If PPV is not possible or not available, then intravitreal antimicrobial therapy, along with systemic and topical medication, with tapping the vitreous to collect a vitreous sample for culture.