Treatment of Endophthalmitis

Diagnosis and Initial Assessment

Definitive diagnosis of endophthalmitis requires direct ophthalmoscopic examination and culture of vitreous humor or aqueous humor specimens, as recommended by the American Academy of Ophthalmology 1
Diagnostic vitreous tap is essential before initiating treatment to identify the causative organism, with a strength of evidence level of high 2

For fungal endophthalmitis, specifically Aspergillus, the Infectious Diseases Society of America recommends administering intravenous amphotericin B and intravitreal amphotericin B when appropriate, with a strength of evidence level of moderate 1
For Candida endophthalmitis, the Infectious Diseases Society of America recommends using fluconazole or voriconazole for susceptible isolates, with a strength of evidence level of high 2
For resistant Candida isolates, the Infectious Diseases Society of America recommends using liposomal amphotericin B with or without oral flucytosine, with a strength of evidence level of moderate 2

Pars plana vitrectomy is a sight-saving procedure in severe cases of endophthalmitis, removing inflammatory debris and infectious organisms, as recommended by the American Academy of Ophthalmology 1
For macular involvement, combining systemic antifungals with intravitreal injection of amphotericin B or voriconazole is recommended, with a strength of evidence level of moderate 2

Treatment duration for endophthalmitis should continue for at least 4-6 weeks, with final duration depending on resolution of lesions, as recommended by the Infectious Diseases Society of America 2
For fungal endophthalmitis with prosthetic valve involvement, the Infectious Diseases Society of America recommends considering lifelong antifungal therapy with an oral triazole, with a strength of evidence level of low 3

Direct macular involvement is a poor prognostic indicator for recovery of visual acuity, with a strength of evidence level of high 1
Regular ophthalmologic follow-up is essential to monitor response to treatment, as recommended by the American Academy of Ophthalmology 2

Subconjunctival antibiotic injections alone are generally ineffective and should not replace intravitreal administration, as recommended by the American Academy of Ophthalmology 1