Diagnostics for endophthalmitis

Infectious endophthalmitis is a serious complication of intraocular surgery, perforating injury, or septic dissemination. Detection of the causative microorganisms is essential for effective treatment. Published positive culture rates vary from 24 to 95 %. To achieve a high positive rate of detection of microorganisms all material necessary to set up a culture has to be available in the operation theatre. Important is a variety of appropriate culture media: we use Columbia, Hematin, ENDO and yeast-cysteine blood plates as well as a nutrient solution. Samples may be brought into the culture media directly within the operation theatre. If no immediate transport to a specialised laboratory is possible, media may be cultured in the eye hospital under optimal conditions. Concurrently, undiluted samples should be used for eubacterial PCR. While standard PCR can only detect the causative microorganism, standard culture procedures provide additional information regarding resistance to antimicrobiological therapies. In the case of presumed fungal endophthalmitis the collected vitrectomy fluid has to be centrifuged and thereafter cultured. In presumed endogenous endophthalmitis also extraocular samples should be examined (e. g., blood culture and smears from other sites of infection). With this approach a high detection rate can be achieved in patients with endophthalmitis.