Post-cataract surgery endophthalmitis presents on day 6 with vision drop to hand movements, hypopyon of 2 mm, and severe vitreous haze. The ESCRS Endophthalmitis Study guides management. Which intervention is definitively indicated in this scenario?

• A Intravitreal vancomycin + ceftazidime injection alone (without vitrectomy)
• B Immediate systemic ciprofloxacin with topical fortified antibiotics
• C Pars plana vitrectomy combined with intravitreal antibiotics ✓
• D IV amphotericin B for suspected fungal endophthalmitis

Explanation

The EVS (Endophthalmitis Vitrectomy Study) showed that immediate pars plana vitrectomy (PPV) with intravitreal antibiotics was superior to intravitreal antibiotics alone when presenting vision was light perception (LP) or worse. In this case, vision is hand movements (HM) — for HM or better, intravitreal antibiotics alone are acceptable per EVS, but with severe vitreous haze and progressive disease on day 6, PPV with intravitreal vancomycin + ceftazidime is the most appropriate combined intervention. Systemic antibiotics showed no benefit over intravitreal in EVS.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.