Controversies in Endophthalmitis Prevention

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Abstract
To REDUCE THE RISK for postoperative endophthalmitis, the use of antibiotics in the intraocular irrigating fluid during routine intraocular surgery has been recommended.1,2Theoretically, these antibiotics reduce the risk for endophthalmitis, but there are no large randomized prospective studies comparing the use of irrigating fluid antibiotics vs a placebo in reducing the incidence of postoperative endophthalmitis. Endophthalmitis can occur in spite of using antibiotics in the irrigating fluid. In an in vitro model, it was demonstrated that exposure to antibiotics for a short period of time generally has no effect on organisms commonly responsible for endophthalmitis.3In clinical practice, endophthalmitis has occurred, for example, in pars plana vitrectomy despite antibiotics in the irrigating fluid. (David Fischer, MD, oral communication, 1995). We have treated one patient with postoperative endophthalmitis after uncomplicated phacoemulsification in which vancomycin hydrochloride was used in the intraocular irrigating fluid. The surgeon must recognize that the