A patient presented to the eye casualty three days after cataract extraction with the following appearance and pain.

• How would you manage this condition?


Answer
The history, signs and symptoms are indicative of 
post-operative endophthalmitis caused by bacterial 
infection. Vitreous biopsy via the par plana should
be performed for Gram staining and culture. Direct intravitreal injection of antibiotics is carried out using amikacin (or gentamicin) and vancomycin (or ceftazidine). 
Depending on the microbiological findings, the treatment 
is then modified accordingly. (See Results of the 
Endophthalmitis Vitrectomy Study. The Endophthalmitis Vitrectomy Study Group. Arch Ophthalmol 1995; 113: 1479-1496)

a

Gram staining of the vitreous biopsy is shown below:

 
• What does the picture show?
a
Answer
Presence of Gram positive bacteria. The bacteria 
shown is Staph. aureus.
Other bacterial infections that often give rise to 
acute fulminant endophthalmitis include Strep. pneumoniae and Strep pyogenes.