Vitreous Tap Research Articles

Management Patterns and Outcomes for Intravitreal Injection-Related Endophthalmitis.

This work describes the clinical management and outcomes in cases of presumed infectious endophthalmitis following intravitreal injection at a tertiary academic medical center. A retrospective review took place of eyes that presented to the Duke Eye Center over a 9-year period and were diagnosed with intravitreal injection-related endophthalmitis. Clinical presentation, management, microbiologic yield, visual outcomes, and complications were abstracted from medical records. Of 23 eyes diagnosed with postinjection endophthalmitis, 52.2% underwent anterior chamber tap (33.3% of which first underwent dry needle vitreous tap), 47.8% underwent needle vitreous tap, 17.4% underwent neither, and none underwent pars plana vitrectomy (PPV) for initial management. Subsequent PPV was performed in 6 eyes (26.1%). Mean visual acuity (VA) improved by 50 Early Treatment Diabetic Retinopathy Study letters at 6 months. Eyes that underwent initial anterior chamber tap had worse presenting VA than those that did not (P = .01). Eyes undergoing subsequent PPV had worse VA at presentation (P = .02) and at 6 months (P < .001). Eyes presenting with VA of hand motion (20/8000) or worse were more likely to undergo subsequent PPV (P = .02). Eyes with intravitreal injection-related endophthalmitis presenting with VA of hand motion or worse were more likely to undergo subsequent PPV. Future studies with larger cohorts may reveal whether earlier vitrectomy should be considered in these patients.

Clinical Presentations and Management Outcomes of Culture-Proven Mixed Bacterial and Fungal Endophthalmitis

ABSTRACT Objective To report the clinical features and management outcomes of mixed fungal and bacterial endophthalmitis Methods Retrospective, consecutive non-comparative case series. Fifteen eyes of 15 patients were included from January 2009 to December 2019 with culture proven mixed fungal and bacterial endophthalmitis. Demography, clinical presentations, interventions received, and final visual and anatomical outcomes were noted. A favorable anatomic outcome was defined as preservation of the globe, absence of hypotony, attached retina, and absence of active inflammation at the last visit. Results The mean age of patients in this series was 34.2 ± 19.6 years (range: 5–61 years). Male preponderance was found in 14 (93.3%). Eight (53.3%) eyes had open globe injury, 5(33.3%) had postoperative endophthalmitis and one (6.6%) each with endogenous endophthalmitis and post-keratitis. Pars plana vitrectomy was done in eight (53.3%) eyes whereas vitreous tap alone was done in seven (46.7%) eyes. Gram positive cocci (n = 11, 73.3%) were the commonest bacterial isolates (n = 7, 46.6%). Staphylococcus aureus (n = 3, 20%) was the most common bacterial isolate. The commonest fungi were filamentous hyaline fungi (n = 5, 33.3%). An unfavorable visual outcome (VA<20/400) was seen in all the eyes. The mean duration of follow-up was 13 ± 18.3 months. Globe salvage was possible only in five (33.3%) eyes. The bacterial isolates were highly sensitive to all of the tested antibiotics. Conclusion Mixed fungal and bacterial endophthalmitis occur commonly in a setting of open-globe trauma. The presence of fungus concurrently leads to a very poor management outcome even if the bacterial isolate sensitivity is good.

EARLY DESCRIPTIONS OF VITREOUS SURGERY.

Vitreoretinal surgical techniques have evolved during the last decades because of the development and evolution of pars plana vitrectomy. The introduction of modern vitrectomy is credited to Robert Machemer (1933-2009). The aim of this review is to characterize the early developments of vitreous removal. We used the PubMed web platform to search the terms: complications of cataract surgery, vitrectomy, vitreous body, vitreous humor, vitreous humour, vitreous tap, and vitreous transplantation. Other publications were also considered as a potential source of information when referenced in relevant articles. The first description of vitreous removal for treatment of eye disorders dates the 17th century; it was conducted by a Dutch surgeon Anton Nuck (1650-1692) in a case of hydrophthalmia. In English literature, the first description of vitrectomy is attributed to the American surgeon John Collins Warren (1778-1856). This method was implemented in the spontaneous dislocation of the crystalline lens. As the fibrillar structure of the vitreous once destroyed could not be regenerated, the researchers aimed to restore the chemical composition of the vitreous. For several decades, vitreous transplantation was performed for the treatment of vitreous hemorrhages and retinal detachment. Although the achievements of vitreoretinal surgery preceding Machemer's inventions are uncommonly reported, they have contributed to the concept and understanding of the treatment modalities.

Good Visual Outcome in Post Traumatic Exogenous Endophthalmitis Caused by Trichophyton Species

Trichophyton species is a dermatophytic fungus commonly found in the skin, nails, hair, and other organic matters such as palm trees and soil. We report a rare case of a 23-year-old man who had a penetrating injury to the eye from the leaves of a palm tree and subsequently developed exogenous endophthalmitis. Culture from the vitreous tap revealed Trichophyton sp as the causative organism. Early vitrectomy and adequate intravitreal injection of amphotericin B resulted in good visual outcomes in an otherwise blinding condition. This is the first reported case of exogenous endophthalmitis secondary to Trichophyton species. Early diagnosis and prompt treatment may help improve visual outcomes.

Ochrobactrum anthropi: A Rare Cause of Culture-Proven Acute Post-Operative Cluster Endophthalmitis

ABSTRACT Aim: To report the clinical presentation and management outcomes of an outbreak of culture-proven post-operative endophthalmitis (POE) secondary to Ochrobactrum anthropi. Methods: This study was conducted at a tertiary-care eye hospital in South India. Results: Fifty-five patients underwent cataract surgery by six surgeons on three consecutive days in the same surgical facility in September 2020. Four patients developed POE after a mean interval of 12.0 ± 4.8 days and underwent immediate vitreous tap and intravitreal antibiotic injections (Vancomycin and Ceftazidime). All patients required a core vitrectomy (culture positive, n = 4/4). Two patients underwent an additional intraocular lens explantation, 2 and 4 months after presentation. All the four patients showed good anatomical and functional recoveries (mean follow-up, 5.75 ± 1.5 months). Two other patients had an exaggerated post-operative inflammation, which was successfully treated with topical medications. Conclusions: O. anthropi is a rare cause of acute POE. Although the isolated organism was multi-drug resistant, the outcome was good in all the patients.

Diagnostic value of culture results from aqueous tap versus vitreous tap in cases of bacterial endophthalmitis

ObjectiveTo investigate the concordance between aqueous and vitreous tap culture results among different types of bacterial endophthalmitis.Methods and analysisThis retrospective cohort analysis included all cases diagnosed with endophthalmitis at Moorfields...

Clinical and visual outcomes following endogenous endophthalmitis: 175 consecutive cases from a tertiary referral center in Taiwan.

To elucidate the linkage between organisms and visual outcome in cases of endogenous endophthalmitis. Patients who presented with signs of endogenous endophthalmitis between January 2008 and December 2015 and underwent a vitreous tapping were enrolled. The patients' demographics and clinical findings were recorded. The outcomes include visual acuity and enucleation. A total of 175 consecutive patients with endogenous endophthalmitis were enrolled. Forty-four percent of the patients had a known distal focus of infection. The most common focus was liver abscess (24.6%), and the major intravitreal isolate was Klebsiella pneumoniae (34.4%). In this series, 51.4% of the intravitreal cultures were positive. The visual acuity of fungal ophthalmitis were better than in bacterial ophthalmitis. Multivariate logistic regression showed that Gram negative vitreous isolates, compared with the negative vitreous culture, were associated with higher risk of enucleation (Odds ratio [OR]: 10.424, 95% confidence interval [95% CI]: 3.019-35.995). The use of intravitreal antibiotics, compared non-users, was associated with a reduced risk of enucleation (OR:0.084, 95% CI: 0.026-0.268). Trans pars plana vitrectomy was not associated with risk of enucleation (OR: 0.307, 95% CI: 0.035-2.693). The post-treatment VA was positively correlated with the presenting VA (r=0.718, p=0.0001). Our study demonstrated that liver abscess is the most common source of endogenous endophthalmitis in Taiwan. The visual outcome is good when the presenting visual acuity is relatively well preserved and when the infecting organism is fungus. The use of intra-vitreal antibiotics reduces the risk of enucleation.

Choroidal Neovascular Membrane Causing Vitreous Hemorrhage from Inactive Chorioretinal Scar due to a Case of Ocular Toxoplasmosis

<h4 class="maintitle">Abstract</h4> We report a case of a choroidal neovascular membrane that developed from a chorioretinal scar in the setting of prior active Toxoplasma chorioretinitis. The patient initially presented as a referral for acutely blurry vision determined to be from a vitreous hemorrhage. She underwent a pars plana vitrectomy, which uncovered an inactive appearing chorioretinal scar. Subsequently, the patient developed a flare-up of Toxoplasma chorioretinitis that was confirmed by positive Toxoplasma polymerase chain reaction after a vitreous sample was obtained via vitreous tap. After the infection was appropriately managed, the patient developed new, albeit smaller, subretinal and preretinal hemorrhage determined to be from a choroidal neovascular membrane in the area of the chorioretinal scar. This bleeding was controlled successfully with multiple intravitreal injections of anti-vascular endothelial growth factor with return to the patient’s baseline visual acuity. <h4 class="maintitle">Keywords</h4> Choroidal neovascular membrane; Vitreous hemorrhage; Chorioretinal scar

Mechanical Eye Trauma Epidemiology, Prognostic Factors, and Management Controversies—An Update

Purpose of Review: The management of eye injuries is both difficult and argumentative. This study attempts to highlight the management of ocular trauma using currently available information in the literature and author experience. This review presents a workable framework from the first presentation, epidemiology, classification, investigations, management principles, complications, prognostic factors, final visual outcome and management debates. Review Findings: Mechanical ocular trauma is a leading cause of monocular blindness and possible handicap worldwide. Among several classification systems, the most widely accepted is Birmingham Eye Trauma Terminology (BETT). Mechanical ocular trauma is a topic of unsolved controversy. Patching for corneal abrasion, paracentesis for hyphema, the timing of cataract surgery and intraocular lens implantation are all issues in anterior segment injuries. Regarding posterior segment controversies, the timing of vitrectomy, use of prophylactic cryotherapy, the necessity of intravitreal antibiotics in the absence of infection, the use of vitrectomy vs vitreous tap in traumatic endophthalmitis is the issues. The pediatric age group needs to be approached by a different protocol due to the risk of amblyopia, intraocular inflammation, and significant vitreoretinal adhesions. The various prognostic factors have a role in the final visual outcome. B scan is used to exclude R.D, Intraocular foreign body (IOFB), and vitreous haemorrhage in hazy media. Individual surgical strategies are used for every patient according to the classification and extent of the injuries. Conclusion: This article examines relevant evidence on the management challenges and controversies of mechanical trauma of the eye and offers treatment recommendations based on published research and the authors’ own experience.

Endophtalmitis associated with flange exposure after a 4-flanged canabrava fixation techique

A 101-year-old woman who underwent 4-flanged intrascleral fixation intraocular lens (ISF IOL) technique surgery in her left eye (elsewhere) 6 months prior to her presentation, was referred to our department due to pain and loss of vision for the previous 4 days. The patient presented with left eye visual acuity of hand motion, conjunctival hyperemia, hypopyon, vitritis, and 2 polypropylene flanges exposed throughout the conjunctiva. Endophthalmitis was diagnosed followed by urgent treatment with vitreous and anterior chamber tap, and intravitreal injections of antibiotics and steroids. Cultures revealed Streptococci viridans infection. No further surgical intervention was performed due to patient opposition. The infection resolved within a few weeks; however, phthisis bulbi developed subsequently. ISF IOL with 4 polypropylene flanges has gained popularity. A rare complication of flange extrusion might lead to endophthalmitis. Studies evaluating short- and long-term complications of this technique are warranted.

Further evidence of the association of latent Mycobacterium tuberculosis in Eales' disease.

To find out association of Eales' disease with Mycobacterium tuberculosis. A retrospective study was done recruiting patients visiting the uvea clinic with diagnosis of Eales' disease from 2015-2019. Seventy-nine eyes of 50 patients diagnosed as Eales' disease underwent Mantoux test, QuantiFERON-TB Gold test, high resolution computed tomography (HRCT) of the chest and anterior chamber or vitreous tap for TB genome polymerase chain reaction(PCR). The study included 41 males and 9 females. The mean age of the patient was 35.62 ± 11.49y. Out of 50 patients, 42% (n = 21) patients had unilateral involvement. Mantoux test was positive in 73% patients. QuantiFERON-TB Gold test was positive in 56% patients. HRCT chest was suggestive of pulmonary tuberculosis in 34% patients. Out of 6 patients, PCR from anterior chamber tap showed TB genome positive in 2 (33.3%) patients. Out of 9 patients, vitreous tap PCR was positive for TB genome in 2 (22.2%) patients. Our study showed that one or more tests were positive for TB in Eales' disease suggesting a pivotal role of TB as a primary etiology for this disease. We conclude that Eales' disease is associated with Mycobacterium tuberculosis infection.

Early vitrectomy for exogenous endophthalmitis following surgery

Objectives This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the potential role of combined pars plana vitrectomy and intravitreal antibiotics in the acute management of exogenous endophthalmitis, versus the standard of care, defined as vitreous tap and intravitreal antibiotics.

Comparative Outcomes of Primary Vitrectomy Versus Tap and Inject for Endophthalmitis Following Phacoemulsification Cataract Surgery

ABSTRACT Purpose To compare functional and anatomical outcomes, rates of culture positivity and number of procedures in eyes with endophthalmitis following phacoemulsification surgery, treated with either primary vitrectomy and intravitreal antibiotics or vitreous tap and antibiotic injection (T&I). Methods Patients developing endophthalmitis after phacoemulsification surgery between 2007 and 2016 were identified, and outcomes were compared between the two treatment groups. Results 19 patients underwent a primary vitrectomy and 22 underwent a T&I. There was a significant improvement in visual acuity after T&I (p=.003) and primary vitrectomy (p=.00005). The median improvement in visual acuity was significantly greater for the primary vitrectomy group than the T&I group (p=.024). 64% of eyes were culture positive with the initial T&I, and 63% with primary vitrectomy (p=1.00). Two eyes initially culture negative with a T&I, and three eyes that were culture positive with a T&I were subsequently culture positive with a vitrectomy 24-72 hours later. 68% of patients who underwent a T&I required an additional procedure, compared to 26% of the vitrectomy group (p=.01). The T&I group underwent a mean of 2.3 procedures each, and the primary vitrectomy group underwent 1.5 (p=.03). Conclusions Eyes with endophthalmitis treated with a primary vitrectomy demonstrated greater visual improvement and needed fewer procedures than those initially treated with a T&I. Viable bacteria were only seen in subsequent procedures in the T&I group, indicating that primary vitrectomy was superior at sterilizing the eye.

Endophthalmitis After Descemet Stripping Endothelial Keratoplasty: Microbiological Yield and Visual Outcomes

To describe the clinical presentation, management, and visual outcomes of 6 eyes with endophthalmitis after Descemet stripping endothelial keratoplasty (DSEK). Retrospective case series. Setting: Tertiary, academic eye center. StudyPopulation: Individuals developing endophthalmitis after DSEK at the Duke Eye Center from January 1, 2009, to January 1, 2018, with at least 6months of follow-up. ObservationProcedure: Retrospective chart review. OutcomeMeasures: Diagnostic procedures, microbiological yield, and visual outcomes. Six eyes of 6 patients were identified. Mean time from surgery to presentation was 51days (range, 4-137days). Dense vitreous opacities were present in all cases. Five of 6 cases (83%) had culture-proven infectious endophthalmitis (2 Candida glabrata, 2 coagulase-negative Staphylococcus, 1 Streptococcus pneumoniae). Aqueous tap yielded positive culture in 2 of 2 cases with adequate sample (100%); needle vitreous tap yielded positive culture in 0 of 3 cases. One eye underwent vitrectomy on presentation, and 3 eyes (50%) underwent subsequent vitrectomy for persistent endophthalmitis after a mean of 37days. Mean pre-endophthalmitis visual acuity (VA) was 20/64; mean VA at 6months was 20/2069 (average 15 ETDRS lines lost). VA at 6months was light perception or no light perception in 3 of 6 cases (50%). One eye underwent enucleation at 6months, and 1 eye became phthisical 1 year after endophthalmitis. DSEK-related endophthalmitis may lead to severe vision loss, even with prompt and appropriate treatment. Aqueous tap had a higher culture yield than needle vitreous tap in our series.

Effect of Intravitreal Antibiotic Injections on Culture-Negative Keratitis-Induced Endophthalmitis

Background This study aimed to evaluate treatment outcomes of culture-negative keratitis-induced endophthalmitis (CNKE). Methods We reviewed the medical records of 13 patients with CNKE, who underwent treatment from January 2011 to December 2017. All patients were referred from the emergency department or outpatient departments of local clinics. Outcome evaluation included the assessment of visual acuity and any need for evisceration/enucleation. Results Thirteen eyes of 13 patients were included in this study. The mean age of the patients was 75.0 ± 13.3 years. All patients had used antibiotic eye drops before the initial visit. Visual acuity values at the initial visit ranged from no light perception to 2/100; final visual acuity values ranged from no light perception to 2/100. All patients underwent a vitreous tap and intravitreal ceftazidime/vancomycin injection. Two eyes underwent evisceration after intravitreal injection. Conclusions Intravitreal antibiotic injections demonstrated favorable results for the treatment of patients with CNKE.

Clinical Course and Characteristics of Eyes with Recurrent Episodes of Endophthalmitis

Infectious endophthalmitis is a devastating, yet rare, complication after intraocular surgery, trauma, and systemic illness. Given its rare incidence, few patients would be expected to experience more than 1 episode of infectious endophthalmitis in their lifetime. We reviewed our patients who were diagnosed with and treated for at least 2 separate episodes of endophthalmitis. A retrospective, consecutive case series was conducted of patients managed at Associated Retinal Consultants PC (Royal Oak, Michigan) from January 2013 through December2019. Patients were identified with the diagnosis of endophthalmitis by International Classification of Diseases, Ninth and Tenth Editions, codes. Those diagnosed and then treated either with a vitreous tap and intravitreal injection of antibiotics or with pars plana vitrectomy at least twice were included. Those treated multiple times for the same episode of endophthalmitis were excluded. Cause and risk factors for recurrent endophthalmitis. Charts of 535 patients were reviewed, and 12 patients met inclusion criteria. The median age at initial presentation was 72.5 years, and 33.3% were men. Eight of the 12 patients (66%) experienced recurrent endophthalmitis in the same eye, and 4 of the 12 patients (33%) experienced separate episodes in different eyes. The average time between episodes was 604 days (range, 90-2366 days). The average follow-up from the second episode was 492 days (range, 119-1185 days). The most common cause for both the first and second episodes was recent intravitreal injection (50% and 58.3%, respectively) followed by surgery associated (41.6% and 33.3%, respectively). The cause was the same for the first and second episodes of 8 patients (75%). Of the 24 recorded episodes of endophthalmitis, culture results were positive in 41.6%, with coagulase-negative Staphylococcus being the most common bacteria identified. Recurrent endophthalmitis is rare and seen most commonly after intravitreal injections. Most patients in this series showed culture-negative results. Each successive episode of endophthalmitis was associated with a worse final visual outcome. The cumulative number of intravitreal injections may be an independent risk factor for recurrent postinjection endophthalmitis.

A NOVEL VITREOUS CULTURE TECHNIQUE.

This is the first case series of a novel method of collecting and transporting a vitreous specimen after a vitreous tap and injection for infectious endophthalmitis. Case series. Four consecutive cases of presumed infectious endophthalmitis underwent an in-office vitreous tap and antibiotic injection. The vitreous specimen was injected into the ESwab liquid-based collection and transport system for microbiology samples. Three of the four cases had a positive culture. The ESwab is a simple and efficacious method of collecting a vitreous specimen, increasing the probability of a positive culture, particularly when there is a delay between specimen collection and delivery to the laboratory for processing.

Bacterial contamination of intravitreal needles by the ocular surface microbiome

PurposeThe ocular surface microbiota are recognised as one of causative microorganisms in post-procedural endophthalmitis but in many cases the vitreous tap is culture negative. This study investigated bacterial contamination of intravitreal (IVT) needles using multiple approaches covering culturing, 16S rRNA gene sequencing, fluorescent in situ hybridisation (FISH) and scanning electron microscopy (SEM). MethodsIVT needles were obtained immediately after injection from patients undergoing treatment for predominantly age-related macular degeneration. Eighteen needles were analysed by culturing on chocolate blood agar. In addition, 40 needles were analysed by extracting DNA and paired-end sequencing of the 16S rRNA gene. Sequences were quality filtered (USEARCH), taxonomically classified (SILVA) and contaminant filtered (DECONTAM). Nine needles were analysed by either FISH using the bacterial probe EUB338 or SEM. ResultsUsing culturing, three bacteria were identified from 5 of 18 needles (28%) - Kocuria kristinae, Staphylococcus hominis and Sphingomonas paucimobilis. The negative control needles showed no growth. Following rigorous data filtering, bacterial community analysis using 16S rRNA gene sequencing showed the presence of predominantly Corynebacterium but also Pseudomonas, Acinetobacter, Sphingomonas, Staphylococcus and Bacillus on the needles. Cocci-shaped cells in a tetrad formation were observed using FISH, while SEM images showed cocci-shaped bacteria in pairs and irregular tetrads. ConclusionsThe study showed evidence for a large diversity of bacteria on IVT needles and visually confirmed their adherence. The diversity was similar to that found on the ocular surface and in conjunctival tissue. This suggests the risk of exogenous endophthalmitis remains even with sterilization of the conjunctival surface.

A Nine-Year Analysis of Practice Patterns, Microbiologic Yield, and Clinical Outcomes in Cases of Presumed Infectious Endophthalmitis

To analyze practice patterns, microbiologic yield, and clinical outcomes in cases of presumed infectious endophthalmitis at a single tertiary academic referral center. Retrospective chart review. Eyes diagnosed with endophthalmitis at the Duke Eye Center between January 1, 2009, and January 1, 2018, that underwent aqueous tap, needle vitreous tap, or mechanical vitreous biopsy with pars plana vitrectomy (PPV) in conjunction with intravitreal antimicrobials. Charts of 133 eyes of 130 consecutive patients were identified and reviewed for etiology of endophthalmitis, ocular history, interventions, visual outcomes, complication rates, and microbiologic culture results. Microbiologic yield and corrected visual acuity (VA) at initial presentation and last follow-up (up to 1 year) were the primary outcome measures. Secondary outcome measures included need for subsequent intervention, retinal detachment (RD) rate, and antimicrobial sensitivities. Of the 133 cases of presumed infectious endophthalmitis, 74% were unrelated to cataract surgery. Initial management included intravitreal antimicrobials with aqueous tap in 46% of eyes, needle vitreous tap in 59% of eyes, and mechanical vitreous biopsy with PPV in 14% of eyes. Twenty-seven percent of cases that underwent initial aqueous or needle vitreous tap required subsequent intervention with PPV. Overall, 45% of endophthalmitis cases were culture proven. Needle vitreous tap and mechanical vitreous biopsy with PPV were more likely to yield culture growth compared with aqueous tap (P= 0.042, P= 0.004, respectively). All isolated bacteria were sensitive to the combination of intravitreal vancomycin and ceftazidime. Eyes that underwent initial mechanical vitreous biopsy with PPV had worse VA at presentation (P= 0.024) and at last follow up (P= 0.011) compared with eyes that underwent initial aqueous tap or needle vitreous tap. An RD occurred within 3-12 months in 13% (17/133) of cases, and of these, 41% had an endogenous etiology. Needle vitreous tap and mechanical vitreous biopsy were more effective in yielding positive cultures compared with aqueous tap; however, culture results may not influence initial intravitreal antimicrobial choice. Eyes with presenting VA between counting fingers and hand motion at 1 foot were more likely to undergo initial PPV.

Endophthalmitis in Oman: A descriptive retrospective multi-center study

PURPOSE:The aim of this study is to report the anatomical and functional outcome, microbiology profile and treatment used for endophthalmitis in Oman.DESIGN:The study design involves retrospective descriptive multicenter study.METHODS:Demographic and clinical data of patients diagnosed with endophthalmitis over a period of 9 years were collected in three tertiary hospitals in Oman.RESULTS:A total of 50 endophthalmitis cases were included in the study. Exogenous endophthalmitis was diagnosed in 48 cases, whereas 2 cases were endogenous endophthalmitis. Culture-positive cases constituted 16 cases (32%) out of these, 12 cases were Gram-positive, 3 cases were Gram-negative and one case had a positive fungal culture. Immediate first-line treatment was vitreous tap and inject in 33 eyes and vitrectomy in 13 eyes. In 45 eyes in which the visual acuity (VA) was recorded; VA after treatment improved in 22 eyes (49%), remained the same in 16 eyes (36%) and worsened in 7 eyes (16%).CONCLUSION:Although endophthalmitis is rare, it is a devastating ocular emergency. Early diagnosis and prompt intervention are crucial in management. Awareness among the patients undergoing intraocular surgeries about this rare condition is very crucial. Moreover, frontline health-care providers must be aware and critical if they encounter patients with suspicion of endophthalmitis as early recognition, prompt referral, and timely treatment are the key for better visual prognosis. Finally, establishing a National Endophthalmitis Registry is recommended as it will help analyze the incidence, treatment instituted and the outcome of this condition across Oman.