A 68-year-old diabetic patient 4 days post-phacoemulsification develops severe pain, visual acuity of hand motion, corneal edema, hypopyon, and vitreous haze. Vitreous tap culture grows coagulase-negative Staphylococcus. Management should be:
- A Intravitreal vancomycin 1 mg/0.1 mL and intravitreal ceftazidime 2.25 mg/0.1 mL injection immediately ✓
- B Topical and systemic antibiotics only
- C Immediate pars plana vitrectomy with intravitreal vancomycin and ceftazidime
- D Subconjunctival antibiotics and topical steroids
Explanation
This is acute post-operative endophthalmitis (within 6 weeks). Per the Endophthalmitis Vitrectomy Study (EVS), eyes with light perception or better visual acuity should receive intravitreal antibiotics (vancomycin 1 mg for gram-positives + ceftazidime 2.25 mg for gram-negatives) with or without intravitreal dexamethasone 0.4 mg. Immediate vitrectomy is indicated only if VA is light perception or worse. Coagulase-negative staph is the most common organism in post-cataract endophthalmitis and has a better prognosis. EVS specifically showed no benefit of IV antibiotics; systemic treatment is not indicated.
Reference: Khurana Comprehensive Ophthalmology, 7th ed.
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Written and medically reviewed by the StethoPrep medical team.