A 70-year-old patient develops acute endophthalmitis 3 days following uncomplicated cataract surgery. Vision has dropped to light perception. The most likely organism and the first-line management are:
- A Staphylococcus epidermidis — intravitreal vancomycin and ceftazidime injection based on EVS guidelines ✓
- B Pseudomonas aeruginosa — systemic ciprofloxacin and topical moxifloxacin
- C Bacillus cereus — immediate pars plana vitrectomy
- D Candida albicans — intravitreal fluconazole injection
Explanation
Post-cataract surgery acute endophthalmitis is most commonly caused by Staphylococcus epidermidis (coagulase-negative staphylococci) from the patient's own conjunctival or eyelid flora. The Endophthalmitis Vitrectomy Study (EVS) established that intravitreal antibiotic injection (vancomycin 1 mg/0.1 mL for Gram-positive cover + ceftazidime 2.25 mg/0.1 mL for Gram-negative cover) is the cornerstone of treatment, combined with systemic corticosteroids after antibiotics. When VA is hand movements or better, intravitreal injection alone is equivalent to vitrectomy + injection. When VA is light perception only, immediate vitrectomy provides superior outcomes per EVS. Systemic antibiotics alone are insufficient. Bacillus cereus is a rare but devastating post-traumatic (soil/vegetation) endophthalmitis requiring urgent vitrectomy. Candida endophthalmitis is endogenous.
Reference: Khurana Comprehensive Ophthalmology, 7th ed.
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Written and medically reviewed by the StethoPrep medical team.