Endophthalmitis Vitrectomy Study

Abstract

To the Editor. —We wish to comment on the recent editorial by Doft 1 concerning the Endophthalmitis Vitrectomy Study (EVS). We are concerned that the choice of initial intravenous antibiotics (ie, ceftazidime and amikacin) may not be the optimal choice for the systemic treatment of endophthalmitis. It is well recognized by retinal specialists that coagulase-negative staphylococci are a common cause of endophthalmitis, particularly following cataract surgery. In our community, there has been an increasing incidence of resistant coagulase-negative staphylococci. Vancomycin has proved to be most efficacious in the treatment of these organisms and is uniformly advised for intraocular injections in the treatment of acute endophthalmitis. We also believe that vancomycin should be used systemically since many of the coagulase-negative staphylococci isolated in our community have been resistant to the cephalosporins and aminoglycosides. We currently use intravenous vancomycin along with one of the third-generation cephalosporins (usually cefotaxime or ceftazidime) for systemic