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LETTER TO EDITOR
Year : 2003  |  Volume : 51  |  Issue : 4  |  Page : 363

Spectrum and clinical profile of post-cataract surgery endophthal-mitis in north India


Correspondence Address:
S Sujatha


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PMID: 14750633

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How to cite this article:
Sujatha S. Spectrum and clinical profile of post-cataract surgery endophthal-mitis in north India. Indian J Ophthalmol 2003;51:363

How to cite this URL:
Sujatha S. Spectrum and clinical profile of post-cataract surgery endophthal-mitis in north India. Indian J Ophthalmol [serial online] 2003 [cited 2020 Nov 26];51:363. Available from: https://www.ijo.in/text.asp?2003/51/4/363/14640

Dear Editor,

We read with interest the article by Gupta et al on post- cataract surgery endophthalmitis in North India.[1] The authors have rightly pointed out the completely different profile of postoperative endophthalmitis in India compared to that seen in developed countries. The high incidence of fungal endophthalmitis found in this study is again usual in studies from tertiary care centers as most bacterial endophthalmitis are managed at the hospital where surgery was done. It is the fungal endophthalmitis that is missed due to inadequate laboratory facilities or because the surgeon has not considered this possibility. These cases are most often referred to higher centers as "not responding to therapy". While the authors deserve to be congratulated on their efforts, some points need clarification:

1. The authors have made no mention of the use of ultrasonography in the evaluation of these eyes with endophthalmitis. Ultrasonography is an indispensable tool in this condition as the media is often hazy and no clear view of the fundus can be obtained. Ultrasonography helps not only to confirm the presence of vitreous infiltration but also detects posterior segment pathology such as retinal detachment, which is important before undertaking any form of surgical intervention.

2. Use of routine chest X-ray in patients with postoperative endophthalmitis as was done in this study seems to be of no significant value.

3. Although the incidence of S. pneumoniae as a causative organism was low in this study, we believe it is important for all patients who present with postoperative endophthalmitis to have a re-evaluation of patency of lacrimal sac by syringing. Chronic dacryocystitis missed at the time of initial surgery is often detected in referred cases of endophthalmitis seen at our hospital S.pneumoniae accounts for 20% of all cases of postoperative endophthalmitis seen at our hospital (unpublished data).

4.Use of intravitreal corticosteriods for postoperative fungal endophthalmitis as was done in this study seems unjustified. If the authors believe that corticosteroid use controls tissue damage due to severe inflammation, then intravitreal corticosteroids should be used in bacterial endophthalmitis as well. It is unlikely that corticosteroid use lessens toxicity of the intravitreal antifungal. While reports do exist of the benefits of intravitreal cortico-steroids in fungal endophthalmitis, some studies have found that use of intravitreal corticosteroids in postoperative endophthalmitis worsens the final outcome.[2]

 
  References Top

1.
Gupta A, Gupta V, Gupta A, Dogra MR, Pandav SS, Ray P, et al. Spectrum and clinical profile of post cataract surgery endophthalmitis in North India. Indian J Ophthalmol 2003;51:139-45.  Back to cited text no. 1
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2.
Shah GK, Stein JD, Sharma S, Sivalingam A, Benson WE, Regillo CD, et al. Visual outcome following the use of intravitreal steroids in the treatment of postoperative endophthalmitis. Ophthalmology 2000;107:486-89.  Back to cited text no. 2
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