Intravitreal administration of antibiotic in the treatment of bacterial endophthalmitis. III. Consensus.

Five years ago, we established the Viewpoints section on the premise that written constructive expression of differences of opinion about ophthalmic problems would increase the level of understanding in the profession. Since we thought that neither eloquence of expression nor vigor of debate would resolve the questions, we avoided a response-rebuttal format and simply asked each author to express his or her point of view along with the evidence supporting it, without seeing the other's manuscript. Rather than rigidly cementing opinions, we hoped this approach would maintain maleable minds in the search for solutions to perplexing problems. In the inaugural Viewpoints section, Baum and Peyman discussed periocular versus intravitreal administration of antibiotics in the treatment of bacterial endophthalmitis (Antibiotic administration in the treatment of bacterial endophthalmitis. I. Baum JL: Periocular injections. II. Peyman GA: Intravitreal injections. Surv Ophthalmol 21:332-346, 1977). Now, in a novel format, the authors reappraise the subject and come to a consensus that minimizes the therapeutic quandary engendered by the original articles. While acknowledging that intravitreal administration of antibiotic is the preferred route for the treatment of bacterial endophthalmitis, the authors emphasize the lack of controlled and randomized clinical trials in this area. Their practical recommendations will assist the ophthalmologist who tries to forestall the devastation of bacterial endophthalmitis.