Treat postop endophthalmitis with vancomycin, amikacin

NUREMBERG, Germany — Patients with postoperative endophthalmitis have better visual outcomes when treated with intraocular vancomycin and amikacin than with other antibiotics, a surgeon here said.

H. Mino de Kaspar told attendees here at the German Ophthalmic Surgeons meeting that, in a study of 258 cases of postop endophthalmitis, the combination of vancomycin and amikacin was more effective in preserving visual acuity than either vancomycin plus gentamicin or gentamicin alone. Further, she said, the addition of pars plana vitrectomy reduced the rate of infection recurrence from 23% to 5%.

Dr. de Kaspar found that patients receiving intraocular vancomycin plus amikacin had best corrected visual acuity outcomes of 20/200, compared with 20/200 for patients treated with vancomycin plus gentamicin and count-fingers visual acuity for those treated with gentamicin alone.

Dr. de Kaspar said improving one’s preoperative endophthalmitis prophylaxis regimen may be a factor in reducing the incidence of postoperative endophthalmitis. There is currently no standardized treatment for management of endophthalmitis, she said.

While the incidence of postop endophthalmitis has declined in recent decades, “for such a dangerous disease the number of cases remains too high to be tolerated,” she said. There are about 2,000 cases per year in the United States, Dr. de Kaspar said.