Prophylaxis

There is no consensus in the literature regarding the type of prophylactic antibiotics in eyes with open globe injury. Oral, topical, and subconjunctival antibiotics are always recommended. Whether intravitreal antibiotics should be used in every case of open globe injury or just in high-risk eyes [11] is an individual decision the surgeon has to make.

O Pearl

Although no scientific study has proven that prophylactic antibiotics reduce the risk of endophthalmitis development, common sense tells us that they do. Antibiotic prophylaxis also makes sense from a medicolegal point of view.

always think about the possibility of endophthalmitis if the eye sustained an open globe injury, and especially if the risk is high (e.g., IOFB, soil contamination, lens injury)

proceed with as complete as possible vitrectomy and proper pharmaceutical therapy as soon as possible

perform vitrectomy as if the condition of the eye were similar to a postoperative endophthalmitis; intraocular injuries make this operation, which is not an easy one even in the postoperative setting, even more complex and difficult leave infected vitreous behind unless visualization is poor and cannot be improved by a meticulous anterio-posterior approach; cleansing of the vitreous cavity should be as complete as possible

Summary

Endophthalmitis is one of the most dreaded complications of an open globe injury. Recognition is not as straightforward as in most cases of postoperative endophthalmitis, due to masking by the injury. The selection of treatment for a posttraumatic endophthalmitis, however, is noncontroversial: prompt vitrectomy with intravitreal, systemic, and topical antibiotics offers the best prognosis. Corticosteroids should also be employed to reduce the deleterious effects of the accompanying inflammation.

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