Han said that human studies show an anti-inflammatory effect of intravitreal steroids, but no definite benefit on visual outcome. One study showed a detriment. There are many more powerful factors at work, such as duration of infection, organism virulence, and efficacy of antimicrobial therapy that may obscure any small or moderate treatment effect from dexamethasone intravitreally, he said. We must still be guided by our own clinical experience with this modality. Endogenous endophthalmitis Early recognition and prompt treatment are important in achieving more-favorable outcomes for endogenous endophthalmitis, a rare but challenging, disease, said Harry W. Flynn, MD, professor of ophthalmology at the University of Miami Bascom Palmer Eye Institute.
Focal disease has a better visual prognosis than more diffuse disease.
The uninvolved crystalline lens can be preserved even when treating with amphotericin B in the vitreous cavity. In addition, debridement of small chorioretinal abscesses is not necessary, as these lesions will resolve into an atrophic scar after successful treatment, he said. Flynn said that a detailed review of past medical history, evaluation of clinical features, and a team approach to disease management result in the correct diagnosis. Differential diagnoses include toxoplasmosis and necrotizing herpetic retinitis, also known as acute retinal necrosis. Long-term intravenous line placement, immunosuppressive therapy, and intravenous drug abuse are predisposing factors.