Overview
Chronic postoperative bacterial endophthalmitis is a serious intraocular infection that occurs after ocular surgery, most commonly cataract surgery. It is characterized by persistent inflammation and potential vision loss.Diagnosis
Diagnosis is typically based on clinical presentation, including persistent intraocular inflammation, pain, decreased visual acuity, and presence of microorganisms in intraocular fluid 1.
Anterior chamber and/or vitreous tap for Gram stain and culture is essential for identifying the causative organism and guiding antibiotic therapy 1.Management
Management involves prompt intravitreal antibiotic injection, often broad-spectrum initially, followed by targeted therapy based on culture and sensitivity results 1.
Intracameral antibiotics are used for prophylaxis 1.
Topical antibiotics are also used in management 1.
Surgical intervention, such as vitrectomy, may be necessary in severe cases or those unresponsive to medical management.Key Recommendations
There is no definitive level I evidence for increased bacterial resistance to intracameral or oral antibiotics prior to or during routine cataract surgery 1.
There is no level I evidence for increased bacterial resistance to topical antibiotic administration 1.
One study showed level III evidence for potential antibiotic resistance when the antibiotic was administered... 1.References
1 Flaxel CJ, Smith JR, Jain N, Kim LA, Kim SJ, Maguire MG et al.. Is there evidence for changes in antibiotic resistance of microorganisms causing postcataract surgery endophthalmitis: a systematic review. BMJ open ophthalmology 2025. link