This handout is for endophthalmitis (intraocular infection). Your care team identified this based on: pain + rapidly decreasing vision within ~6 weeks of cataract / intraocular surgery — acute postoperative endophthalmitis until excluded (evs results arch ophthalmol 1995 pmid 7487614).
Other reasons your team may use this plan: pain / redness / floaters / vision loss days after an intravitreal anti-vegf injection — post-injection endophthalmitis (morioka sci rep 2020 pmid 33335269; bates ophthalmol retina 2025 pmid 40158626); open-globe injury or retained intraocular foreign body with developing pain, hypopyon, vitritis — post-traumatic endophthalmitis; bacillus cereus fulminant risk (silpa-archa int j ophthalmol 2020 pmid 33344198; gupta eur j ophthalmol 2007 pmid 17671943); painful red eye with hypopyon, dense vitritis, and a lost/dim red reflex — endophthalmitis until proven otherwise (evs microbiologic factors am j ophthalmol 1996 pmid 8956638).
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| vancomycin | 1 mg/0.1 mL intravitreal | intravitreal | once; repeat at 48-72 h if no improvement | EVS Results Arch Ophthalmol 1995 PMID 7487614 / EVS microbiologic factors Am J Ophthalmol 1996 PMID 8956638 — empiric gram-positive cover (coag-neg staph, S. aureus incl. MRSA, streptococci, enterococci, Bacillus) given immediately at the tap, before culture |
| ceftazidime | 2.25 mg/0.1 mL intravitreal | intravitreal | once; repeat at 48-72 h if no improvement | EVS Results PMID 7487614 — empiric gram-negative cover incl. Pseudomonas; preferred over an aminoglycoside (less retinal toxicity) as the standard intravitreal partner to vancomycin |
| amikacin | 0.4 mg/0.1 mL intravitreal | intravitreal | once | EVS used systemic ceftazidime+amikacin; intravitreal amikacin is the gram-negative substitute only when ceftazidime is unsuitable — macular-infarction risk mandates caution (EVS Results PMID 7487614) |
| vitreous_aqueous_tap_for_gram_stain_and_culture | — | — | — | EVS microbiologic factors Am J Ophthalmol 1996 PMID 8956638 — diagnostic tap taken AT the injection; empiric therapy is never delayed for the result |
Plan: Endophthalmitis — immediate tap-and-inject + vitrectomy decision + endogenous systemic arm
Call 911 or go to the nearest emergency room right away if you have:
Track final visual outcome (EVS prognostic anchors), retinal/vitreous sequelae (RD, epiretinal membrane, macular damage), and silicone-oil/secondary-surgery needs. PREVENTION (a core deliverable): povidone-iodine antisepsis + intracameral cefuroxime for cataract surgery (ESCRS ~5-fold reduction); meticulous injection antisepsis (antibiotic prophylaxis does NOT help); prompt open-globe repair + IOFB removal; bleb-leak surveillance and patient education on the bleb-endophthalmitis lifetime risk; treat the systemic source and screen the fellow eye in endogenous disease.
Guideline: Endophthalmitis Vitrectomy Study — Results (Endophthalmitis Vitrectomy Study Group, Arch Ophthalmol 1995;113(12):1479-96, PMID 7487614) + EVS microbiologic factors (Am J Ophthalmol 1996;122(6):830-46, PMID 8956638) + EVS diabetes subgroup (Arch Ophthalmol 2001, PMID 11346391) + ESCRS prophylaxis study (Barry et al, J Cataract Refract Surg 2006;32(3):407-10, PMID 16631047) + post-intravitreal-injection endophthalmitis registries (Morioka Sci Rep 2020 PMID 33335269; Bates/Storey Ophthalmol Retina 2025 PMID 40158626) + endogenous endophthalmitis series (Chuang Taiwan J Ophthalmol 2025 PMID 40584198; Yang Ophthalmic Res 2020 PMID 31940653; Rodríguez-Adrián Medicine 2003 PMID 12792305) + post-traumatic series (Silpa-Archa Int J Ophthalmol 2020 PMID 33344198; Gupta Eur J Ophthalmol 2007 PMID 17671943) — AAO Preferred Practice Pattern doctrine (tap-and-inject within hours, empiric intravitreal vancomycin + ceftazidime, vitrectomy by the EVS vision criterion)