Indian Journal of Ophthalmology

: 2003  |  Volume : 51  |  Issue : 4  |  Page : 363--364

A Letter

A Salman, P Parmar 

Correspondence Address:
A Salman

How to cite this article:
Salman A, Parmar P. A Letter.Indian J Ophthalmol 2003;51:363-364

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Salman A, Parmar P. A Letter. Indian J Ophthalmol [serial online] 2003 [cited 2024 Feb 26 ];51:363-364
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Dear Editor,

I read with interest the informative article by Gupta et al.[1] The authors have highlighted the high incidence of fungal endophthalmitis reported in their hospital when compared to the Endophthalmitis Vitrectomy Study (EVS) [2],[3]and studies from India[4] and other parts of the world. The authors should be complimented for this very informative work. However, I would like to make the following comments.

The authors have included all patients presenting to their Retina department with signs and symptoms suggestive of endophthalmitis. These patients, referred from other hospitals, might have already received treatment as cases of either severe postoperative uveitis or early endophthalmitis, depending on the presenting signs (which are not described). The preliminary treatment given could possibly have been the precipitating factor for superadded fungal infection in these patients. Moreover, samples obtained from patients who had received a combination of antibacterials and corticosteroids would probably not show bacteria on smear examination, nor would bacteria be isolated in culture of such samples. This might have skewed the results so that the perceived incidence of fungal endophthalmitis might have been higher than it actually is. The authors should have restricted the study group to patients operated in their own institute to ensure uniformity in sterilisation techniques, viscoelastics, irrigating fluids and intraocular lenses used and postoperative treatment protocols.

Use of half-strength povidone iodine 5% in the conjunctival cul-de-sac for a few minutes before surgery and preoperative antibiotic drops are known to decrease the microbial load. Use of balanced salt solution (BSS) in glass bottles for irrigation and aspiration, instead of plastic bottles, may be helpful as any turbidity noted may make the surgeon cautious. Such contaminated solutions are a known cause of endophthalmitis. Personal hygiene of the patients, especially the care of the feet, should be emphasized. The feet may be a nidus of soil contamination, and fungal spores in such soil-contaminated feet may be transferred to the theatre premises, therein posing a potential risk factor for infection.


1Gupta 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.
2Endophthalmitis Vitrectomy Study Group. Results of the Endophthalmitis Vitrectomy Study. Arch Ophthalmol 1995;113:1479-95.
3Johnson MW, Doft BH, Kelsey SF, Barza M, Wilson LA, Barr CC, et al. The Endophthalmitis Vitrectomy Study. Relationship between clinical presentation and microbiologic spectrum. Ophthalmology 1997;104:261-72.
4Anand AR, Therese KL, Madhavan HN. Spectrum of aetiological agents of postoperative endophthalmitis and antibiotic susceptibility of bacterial isolates. Indian J Ophthalmol 2000;48:123-28.