Post-cataract surgery endophthalmitis due to Staphylococcus epidermidis most commonly presents at which time point, and what is the first-line treatment if visual acuity is hand movements or better?

• A Within 24 hours; immediate vitrectomy
• B 4–7 days; immediate PPV plus intravitreal vancomycin and ceftazidime
• C 6 weeks; topical fortified antibiotics and systemic ciprofloxacin
• D 4–7 days; intravitreal antibiotics (vancomycin + ceftazidime) without immediate vitrectomy ✓

Explanation

Acute postoperative endophthalmitis (most commonly Staph. epidermidis) typically presents 4–7 days after surgery. The Endophthalmitis Vitrectomy Study (EVS) established that for VA of hand movements or better, immediate intravitreal antibiotics (vancomycin 1 mg/0.1 mL + ceftazidime 2.25 mg/0.1 mL) without immediate PPV is equivalent to PPV in outcomes. Immediate PPV is reserved for VA of light perception or worse. Topical antibiotics do not achieve therapeutic intraocular levels.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

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