acute postoperative endophthalmitis are rare after vitrectomy in my experience because this procedure implicates the "washing" of the eye with a high volume of liquid. Nevertheless it is possible.
First perform an ultrasound examination just to analyses the status of the retina and to see if infection is located behind the lens (natural or artificial). If patient is phakic consider to remove the lens
perform a vitreous tap and try to identify the microorganism. it should be very aggressive and intravitreal and systemic antibiotics must be added to the vitrectomy
and do not wait for a second vitrectomy for removing the inflammatory/infectious material. The prognosis of the eye depends on it
and good luck with the patient
Agreed. Post-vitrectomy endophthalmitis is rare for the reasons stated in the last comment. When it occurs, remember that the only wounds may be through the pars plana, and there is most likely posterior involvement. You can follow the guidelines of the EVS, but I would have a lower threshold for returning to the OR. If there is any delay, do a tap and inject and then plan to return to the OR with intraoperative antibiotics.
I agree with the comments already made, however these are immediate post vitrectomy cases. In today's world the patient may have had a complete vitrectomy years prior and develop an endophthalmitis from an injection for various conditions. In these cases tap and inject vs. vitrectomy would be based on the the severity and circumstances, but you can alway tap and inject and still go to the OR.
Unfortunately, endophthalmitis following vitrectomy is not the same as endophthalmitis after cataract surgery, the outcome is typically poor and worse than endophthalmitis following cataract surgery. The reason for the worse outcome in eyes undergoing vitrectomy relative to cataract surgery is firstly due to the eyes having less visual potential but also since the observed intraocular infection is more severe with more virulent organisms. First, and most importantly, prompt intra-vitreal antibiotics should be given. These antibiotics should cover both Gram-positive and Gram-negative bacteria, and ideally be prepared by the pharmacy in sterile conditions and readily available to the clinician. At the same time, prior to antibiotic injection a vitreous cavity sample and anterior chamber sample should be sent safely for immediate microscopy, culture, sensitivity and PCR. Other treatment options include topical antibiotics, systemic antibiotics, revision vitrectomy and systemic steroids. Since the outcomes are poor, if intravitreal antibiotics do not seem to improve the situation, I prefer to repeat vitrectomy plus intravitreal antibiotics early on.
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