A 65-year-old diabetic patient presents 5 days after uncomplicated phacoemulsification with pain, decreased vision, hypopyon, and vitritis. Vitreous aspirate Gram stain shows Gram-positive cocci in clusters. The most appropriate treatment according to Endophthalmitis Vitrectomy Study (EVS) guidelines for this scenario (presenting vision light perception or worse) is:
- A Intravitreal antibiotics alone (vancomycin + ceftazidime)
- B Topical and systemic antibiotics with vitrectomy only if no improvement in 48 hours
- C Evisceration to prevent panophthalmitis
- D Immediate pars plana vitrectomy followed by intravitreal antibiotics ✓
Explanation
The Endophthalmitis Vitrectomy Study (EVS) showed that for post-cataract bacterial endophthalmitis with presenting vision of light perception only (the worst category), immediate PPV significantly improved visual outcomes compared with intravitreal antibiotics alone. For patients with vision better than LP (hand movements or worse on EVS criteria should be careful: the EVS showed benefit for LP only). Per EVS, LP vision at presentation is the key threshold: if vision is LP, perform PPV; if HM or better, intravitreal antibiotics alone are equivalent to PPV. The EVS benefits of PPV apply to LP vision — the question specifies LP or worse, so immediate PPV is appropriate.
Reference: Khurana Comprehensive Ophthalmology, 7th ed.
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Written and medically reviewed by the StethoPrep medical team.