2017-10: Towards better treatment of postoperative endophthalmitis.
Patients with postoperative or postinjection suspected bacterial endophthalmitis are our patients with the most acute presentation and rapid progress to blindness of the affected eye. Prompt antibiotic treatment is crucial for the outcome of the patient. Currently, however, the correct diagnosis of bacterial endophthalmitis depends on the demonstration of bacterial growth on standard tissue culture. Because growth on culture plates is dependent on viable microorganisms, the vitreous biopsy has to be taken before the start of empiric antibiotic treatment, a delay of many hours, particularly when the biopsy is taken at the operation theatre.
It would be much preferable to start empiric antibiotic therapy at the first suspicion of bacterial endophtalmitis. Newer microbiological techniques that recognize no longer viable pathogens by the presence of their DNA would make this step possible.
To compare the results of micelle PCR with deep sequencing and classical culture, we will prospectively collect vitreous samples of patients presenting with endophthalmitis to ErasmusMC and the Rotterdam Eye Hospital, and also study remaining earlier vitreous samples of endophthalmitis patients at the Rotterdam Eye Hospital.
If the results of the newer techniques are equivalent to standard bacterial culture, we will start a new treatment protocol with immediate intravitreal injection of empiric antibiotics with later biopsy and compare clinical results with a carefully documented cohort of study patients.