ESCRS Guidelines on prevention, investigation and management of

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5.7 FLOW CHART – TREATMENT GUIDELINES FOR
CHRONIC ENDOPHTHALMITIS
(presumed and not proven) [205]
Make a clinical diagnosis
Investigate for a microbial source
CONDUCT A TRIAL OF THERAPY WITH CLARITHROMYCIN 250mg twice daily for two weeks
(this derivative of erythromycin is well absorbed orally, penetrates well into the eye and is
concentrated 200 times into PMNs and macrophages, to kill intra-cellular Gram-positive bacteria
and Haemophilus sp., but not other Gram-negative rods; clarithromycin is also effective against
many atypical bacteria) [115], [201], [205]
If successful, retain IOL but if therapy fails, make a decision on whether to retain or remove the
IOL and consider performing a vitrectomy possibly combined with a posterior capsulectomy [160]
If IOL is retained, give trial of therapy with intravitreal vancomycin and cefazolin or cefuroxime,
together with intravenous therapy for one week
If combination anti-microbial therapy fails as well, remove the IOL – collect samples
of capsule fragment for histology, electron microscopy and microbiology investigation
(Gram stain, culture & PCR) [47], [202], [205]
Inflammation usually subsides after the IOL has been removed with the capsule but further
antibiotic therapy can be given, such as an oral quinolone, but may not be needed