Infectious Endophthalmitis: Trends in Microbiology, Management, and Surgical Techniques

The purpose of this review is to provide an update on etiologies, preventive practices, management options, and surgical techniques for infectious endophthalmitis. A literature search was conducted for studies published over the past 5 years. Endophthalmitis continues to be an uncommon but dangerous complication following cataract surgery. Recently, intravitreal injections have become heavily utilized as a treatment for various ocular diseases, leading to a greater incidence of postinjection infections. Likewise, long-term risk of endophthalmitis should always be a consideration following glaucoma surgery and implanted drainage devices. Although significant overlap exists for causative organisms among the different etiologies, more targeted studies are needed to better optimize treatment. There has been a lack of updates to treatment guidelines since the Endophthalmitis Vitrectomy Study was published in 1995. Despite promising outcomes seen with newer surgical techniques, the lack of randomized clinical trials represents a major barrier to widespread implementation of these approaches. Povidone-iodine prophylaxis remains the primary evidence-based technique for decreasing the rates of endophthalmitis following intraocular procedures. Intracameral antibiotics have gained momentum in recent years and represent a step forward in mitigating the risk of infection with cataract surgery, although some debate still exists. Newer surgical techniques for vitrectomy that improve visualization, minimize surgical trauma, and decrease operative time would benefit from large-scale randomized trials