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A re-evaluation of 
a constant threat

Leigh Spielberg

Posted: Sunday, September 1, 2019

The risk of endophthalmitis was, until relatively recently, on every cataract surgeon’s mind during and after every single procedure. Although this perpetual fear has been significantly reduced by the introduction and general acceptance of intracameral antibiotics, we still need to remain alert.

Endophthalmitis: A Guide to Diagnosis and Management (Springer), edited by Taraprasad Das, is a re-evaluation of the threat in this new phaco-prophylactic era. But cataract surgery is of course not the only context in which endophthalmitis can occur. Intravitreal injections have not yet benefited from the same prophylactic measures as cataract surgery.

This 400-page book is divided in to seven parts. ‘Part I: General Features’ strives to define endophthalmitis and differentiate it from differential diagnoses such as TASS. ‘Part II: Specific Endophthalmitis’ deals with each cause of this complication, such as blebs, trauma, endogenous infection and keratoplasty, among many others. ‘Part III: Pharmacology’ tackles the science of endophthalmitis treatment, whereas ‘Part IV: Microbiology’ informs the reader about the best methods to collect ocular specimens and interpret the results, including molecular diagnostic methods. ‘Part V’ takes it one step further, describing the pathology of endophthalmitis.

Most interesting to the clinician might be ‘Part IV: Prophylaxis and Prevention’, including “Guidelines for Safe Surgery”, whereas anyone involved in research will appreciate ‘Part VII: Clinical Trials in Endophthalmitis’.

I found Chapter 5 to be particularly interesting for my own clinical practice. Entitled “Epidemiology of Endophthalmitis and Treatment Trend in Europe”, this chapter reviews the development of the current guidelines, which were largely coordinated by the ESCRS. 
And, as a cataract and vitreoretinal surgeon who also administers a significant number of intravitreal anti-VEGF injections, the specific chapters on endophthalmitis occurring after each of these three drew my attention. How best to manage endophthalmitis once it occurs is also of great importance to me, as it often involves close collaboration with the microbiologist and occasionally the pharmacist, interactions that I otherwise am not frequently required to do.

This book is useful not only for ophthalmic surgeons, but for any ophthalmologist, whether in training or in practice, who might encounter a patient with endophthalmitis.