Postoperative endophthalmitis: optimal management and the role and timing of vitrectomy surgery.

PURPOSE: To review the evolving role of pars plana vitrectomy, as well as other therapeutic modalities, in the treatment and prevention of postoperative endophthalmitis and its sequelae.
METHODS: Medline database searches and review of recent relevant literature on the prevention and treatment of postoperative endophthalmitis.
RESULTS: Despite significant technologic advances in ophthalmic surgery and the ready availability of improved pharmacologic agents, the rates of postoperative endophthalmitis have dramatically increased over the last decade. New surgical procedures, interventions, and techniques have increased patient exposures to this serious surgical complication. Cause, presentation, and outcome vary significantly requiring a tailored approach to each case. Appropriate prophylaxis and good surgical technique remain the mainstays of prevention. Intravitreal antibiotics and pars plana vitrectomy remain the primary treatment options.
CONCLUSIONS: Postoperative endophthalmitis is a complex and multifaceted entity with potentially grave visual consequences. It requires a multifaceted approach, including appropriate prevention and prophylaxis, rapid recognition, and aggressive management. Since publication of the Endophthalmitis Vitrectomy Study, improvements in pharmacologic agents and vitrectomy techniques have refocused debate on the role of early surgical intervention in this condition.