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RECOGNITION, TREATMENT AND PREVENTION OF ENDOPHTHALMITIS UPDATED: 2015

Harry W. Flynn, Jr., MD Bascom Palmer Eye Institute University of Miami School of Medicine

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RECOGNITION, TREATMENT, AND PREVENTION OF ENDOPHTHALMITIS: UPDATE 2014 Harry W. Flynn, Jr., M.D. Bascom Palmer Eye Institute University of Miami, Miller School of Medicine

A.

Classification (most frequent organisms in various clinical settings): 1. Postoperative: a. Acute-onset postoperative endophthalmitis: Coagulase (-) staphylococci, Staphylococcus aureus, Streptococcus species, Gram negative bacteria b. Delayed-onset (chronic) pseudophakic endophthalmitis (> 6 weeks postop): P. acnes, coagulase (-) staphylococci, Fungi c. Conjunctival filtering bleb-associated endophthalmitis: Streptococcus species, Hemophilus influenza, staphylococcus species 2. 3. 4. 5.

B.

Post-traumatic: Bacillus species (30-40%), staphylococcus species Endogenous: Candida species, S. aureus, Gram-negative bacteria Keratitis-associated: Pseudomonas, staphylococcus Intravitreal injection-associated: Staphylococcus/Streptococcus

Acute-onset postoperative endophthalmitis at BPEI (Wykoff et al.):

Procedure CE + IOL PPV PK Secondary IOL Glaucoma Totals

1984-1994

1995-2001

2002-2009

#/total Incidence 34/41,654 0.08% 03/6,557 0.05% 05/2,805 0.18% 05/1,367 0.37% 04/3,233 0.12% 51/55,616 0.09%

#/total Incidence 08/21,972 0.04% 02/7,429 0.03% 02/2,362 0.08% 01/485 0.21% 04/1,970 0.20% 17/34,218 0.05%

#/total Incidence 08/28,568 0.03% 02/18,492 0.01% 03/2,788 0.11% 01/1,783 0.06% 00/5,041 0.00% 14/56,672 0.03%



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Acute-onset endophthalmitis after cataract surgery (2002-2013) at BPEI by year: 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Total



00/2809 03/2883 01/2957 01/3344 01/3544 01/3929 00/4218 01/4884 00/4865 00/5211 03/4861 04/4729 02/4340 17/52574

0.00 0.10 0.03 0.03 0.03 0.03 0.00 0.02 0.00 0.00 0.06 0.08 0.05 0.03*

*Without the use of intracameral antibiotics



2. Post-traumatic endophthalmitis (incidence) a. After penetrating injury (larger studies) • Barr (1982) (3.2%) 04/122 • Brinton (1984) (7.4%) 19/257 • Thompson (1995) (5.0%) 13/258 b. With retained intraocular foreign body (IOFB) • Culotta (1983) (8.3%) 08/96 • Williams (1988) (13%) 14/105 • National Eye Trauma System (1993) (6.9%) 34/492 I. Metallic IOFB (7.2%) II. Non-metallic IOFB (7.3%) III. Organic IOFB (6.3%) 3. Endogenous endophthalmitis- associated risk factors: a. Elderly or debilitated patients b. IV drug abuse c. Indwelling catheters d. History of abdominal surgery

4. 5.

Keratitis associated- increased in advanced corneal ulcers and keratoprosthesis Intravitreal injection- 1/2000 to 1/5000

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C. Diagnostic Features 1. Postoperative endophthalmitis a. Acute-onset endophthalmitis- signs and symptoms: • Marked intraocular inflammation • Hypopyon • Reduced vision (marked) • Pain (75%) b. Delayed-onset endophthalmitis- signs: • P. acnes- white intracapsular plaque, granulomatous uveitis, fibrin strands in anterior chamber. Vitritis. • Coagulase negative staphylococcus- vitritis, hypopyon. • Fungi- vitreous infiltrates, “string of pearls” lesions. c. Bleb-associated endophthalmitis- purulent bleb, hypopyon, marked intraocular inflammation.

2. 3. 4. 5.

Trauma- hypopyon, periphlebitis, vitreous infiltrates around IOFB Endogenous- chorioretinal infiltrate, vitritis, history of systemic disease Keratitis- marked intraocular inflammation Intravitreal injections- fibrin/marked intraocular inflammation

D. Clinical Setting for Treatment (usually outpatient) 1. Needle tap (usually performed in minor OR) a. Peribulbar anesthesia b. Povidone-iodine prep c. 23 gauge needle (one inch)- may use butterfly needle d. Inject IOABs in separate syringes 2. Pars plana vitrectomy (PPV)- Transconjunctival PPV 23 or 25 gauge a. Peribulbar anesthesia b. Povidone-iodine prep c. 2 instrument approach (when view limited) vs. standard 3 port PPV d. Inject IOABs in separate syringes E. Clinical Management of Suspected Acute-Onset Bacterial Endophthalmitis 1. Initial approach (usually outpatient treatment) a. Obtain intraocular specimen by needle tap or by vitrectomy (See EVS for general guidelines) (use peribulbular anesthesia) b. Administer intraocular antibiotics (0.1 ml of each) c. Administer intraocular steroids (0.1 ml – optional) d. Consider periocular antibiotics and steroids e. Postoperative topical antibiotics, steroids, and cycloplegics (started on the first morning after initial treatment) f. Postoperative systemic antibiotics (generally not used; can be considered for the more severe cases: rapid onset, LP vision, large hypopyon, no red reflex)

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2. Follow-up approach a. If clinically worsening status at 48-72 hours, consider repeating intraocular cultures and/or re-injection of intraocular antibiotics (and intraocular steroids). Consider vitrectomy if not performed initially. b. Change topical antibiotics if indicated by results of cultures and/or clinical course 3. Evaluate Risk Factors a. Systemic immunosuppression (DM, PR) b. Operative preparation (Xylocaine jelly before Povidone-iodine prep) c. Intraoperative complications (vitreous loss) d. Perioperative factors (surface bacteria) e. Wound construction (wound leak; inferior wound placement) f. Chronic blepharitis F. Recommended Initial Antibiotic and Drug Therapy 1. Acute-onset Postoperative Bacterial Endophthalmitis: a. Intravitreal: • Vancomycin 1 mg/0.1 ml • Ceftazidime 2.25 mg/0.1 ml or Amikacin 0.4 mg/0.1 ml • Dexamethasone 0. 4 mg/0.1 ml (optional) b. Periocular (subconjunctival): Optional • Vancomycin 25 mg • Ceftazidime 100 mg • Dexamethasone 12 to 24 mg c.

Topical (started on first postoperative day): Optional • Vancomycin 25 mg/ml q 1 hour (during day) • Ceftazidime 50 mg/ml q 1 hour (during day) • Topical steroids and cycloplegics (q.i.d)

d. Systemic: usually none (when used, it is generally reserved for eyes with more severe inflammation, LP vision, rapid-onset, glaucoma drainage device, panophthalmitis) • Vancomycin 1 gram IV q 12 hours • Ceftazidime 1 gram IV q 12 hours (or oral fluoroquinolone for susceptible organisms) 2. Delayed-Onset (Chronic) Postoperative Endophthalmitis (Clinical Diagnosis: Bacterial vs. Fungal* Etiology Necessary): a. Intravitreal: (bacterial cases) • Vancomycin 1.0 mg/0. 1 ml • Ceftazidime 2.25 mg/0.1 ml or Amikacin 0.4 mg/0.1 ml • Dexamethasone 0.4 mg/0. 1 ml (optional) *(Amphotericin 0.005 mg/0.1 ml or Voriconazole 0.1mg/0.2ml in suspected fungal cases)

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b. Periocular (subconjunctival): Optional • Vancomycin 25 mg • Ceftazidime 100 mg • Dexamethasone 12 to 24 mg c.

Topical (started on first postoperative day): Optional • Vancomycin 25 mg/ml q 1 hour (during day) • Ceftazidime 50 mg/ml q I hour (during day) • Topical steroids and cycloplegics (q.i.d)

d. Systemic: (usually none but consider in more severe cases) (bacterial vs. fungal etiology) 3. Conjunctival Filtering Bleb-Associated or Glaucoma Device Endophthalmitis: a. Intravitreal: • Vancomycin 1 mg/0.1 ml • Ceftazidime 2.25 mg/0.1 ml or Amikacin 0.4 mg/0.1 ml • Dexamethasone 0.4 mg/0.1 ml (optional) b. Periocular (subconjunctival): Preferred • Vancomycin 25 mg • Ceftazidime 100 mg • Dexamethasone 12 to 24 mg c.

Topical (started on first postoperative day): • Vancomycin 25 mg/ml q 1 hour (during day) • Ceftazidime 50 mg/ml q 1 hour (during day) • Topical steroids and cycloplegics (q.i.d)

d.

Systemic: usually none but consider oral fluoroquinolone in eyes with marked inflammation, LP vision, rapid-onset



4. Post-Traumatic Endophthalmitis a. Intravitreal: • Vancomycin 1 mg/0.1 ml • Ceftazidime 2.25 mg/0.1 ml or Amikacin 0.4 mg/0.1 ml) • Dexamethasone 0.4 mg/0.1 ml (optional) b. Periocular (subconjunctival): Preferred • Vancomycin 25 mg • Ceftazidime 100 mg • Dexamethasone 12 to 24 mg c.

Topical (started on first postoperative day): • Vancomycin 25 mg/ml q 1 hour (during day) • Ceftazidime 50 mg/ml q 1 hour (during day) • Topical steroids and cycloplegics (q.i.d)

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d.

5.

Systemic (generally reserved for more severe cases): • Vancomycin 1 gram IV q 12 hours • Ceftazidime 1 gram IV q 12 hours or oral fluoroquinolone

Endogenous Fungal Endophthalmitis a. Intravitreal: • Voriconazole 0.1mg/0.2ml or Amphotericin-B 0.005 mg/0.1 ml • Usually do not use Dexamethasone 0.4 mg/0.1 ml

b.

Periocular (subconjunctival): Optional • Vancomycin 25 mg and • Dexamethasone 12 mg to 24 mg (must have anti-fungal coverage)

c.

Topical (started on first postoperative day): • Topical steroids and cycloplegics (q.i.d) • Topical amphotericin-B has poor intraocular penetration and is not used

d. Systemic antibiotics (selected in consultation with internist): • Voriconazole 200 mg p.o. b.i.d. for 2-4 weeks or • Fluconazole 200 mg p.o. b.i.d. for 2-4 weeks or • Itraconazole 200 mg p.o. b.i.d. for 2-4 weeks or • Ketoconazole 200 mg p.o. b.i.d. for 2-4 weeks or • Amphotericin B 0.25 to 1.0 mg/kg of body weight/IV over 6 hours as tolerated (only if disseminated disease present) 6. Endogenous Bacterial Endophthalmitis a. Intravitreal: • Vancomycin 1.0 mg/0.1 ml • Ceftazidime 2.25 mg/0.1 ml or Amikacin 0.4 mg/0.1 ml • Dexamethasone 0.4 mg/0.1 ml (optional) b. Periocular (subconjunctival): Optional • Vancomycin 25 mg • Ceftazidime 100 mg • Dexamethasone 12 to 24 mg c.

Topical (started on first postoperative day): • Vancomycin 25 mg/ml q 1 hour (during day) • Ceftazidime 50 mg/ml q 1 hour (during day) • Topical steroids and/or cycloplegics (q.i.d)

d. Systemic antibiotics (selected in consultation with internist): • Vancomycin 1 gram IV q 12 hours • Ceftazidime 1 gram IV q 12 hours (or Oral fluoroquinolones for susceptible organisms)

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G.

Preparation of Intravitreal Antibiotics/Antifungals

NOTE: Intraocular antibiotics are prepared in a volume of 10 ml or greater volume and labeled in a sealed sterile vial. The physician will withdraw the appropriate dose in a tuberculin syringe for injection into the eye. Vancomycin (VANCOCIN) 1 mg/0.1 ml 1. Begin with 500 mg vial of Vancomycin (this is a powder) 2. Add 10 ml of 0.9% Sodium Chloride for Injection, USP (no preservatives) (or BSS) to 500 mg vial in #l 3. Inject 2 ml of solution #2 into a sterile empty vial 4. Add 8 ml of 0.9% Sodium Chloride for Injection, USP (no preservative)(or BSS) to produce a solution containing 1 mg/0.1 ml Vancomycin 5. Seal the vial containing solution #4. Ceftazidime (FORTAZ) 2.25 mg/0.1 ml 1. Begin with 500 mg vial of Ceftazidime (this is a powder) 2. Add 10 ml of 0.9% Sodium Chloride for Injection, USP (no preservatives) (or BSS) to 500 mg vial in #1 3. Inject 1 ml of the solution #2 into an empty sterile vial. 4. Add 1.2 ml of Sodium Chloride for Injection, USP (no preservatives) into the vial #2 to produce a solution containing 2.25 mg/0.1 ml ceftazidime. 5. Seal the vial containing solution #4. Amikacin (AMIKIN) 0.4 mg/0.1 ml 1. Begin with 500 mg/2 ml vial of amikacin 2. Inject 0.16 ml of solution #1 (40 mg) into sterile empty vial 3. Add 9.84 ml of 0.9% Sodium Chloride Injection, USP (no preservatives to produce a solution of 0.4mg/0.1 ml amikacin 4. Seal the vial containing #3 Amphotericin B (FUNGIZONE) 0.005 mg/0.1 ml 1. Begin with a vial containing 50 mg of amphotericin B 2. Add 10 ml of Sterile Water for Injection USP (no preservatives) to vial in # 1 3. Inject 0.1 ml of solution #2 into a steril empyt vial 4. Add 9.9 ml of Sterile Water for Injection, USP (no preservatives) to vial in #3 to produce a solution containing 0.0005 mg/0.1 ml amphotericin B 5. Seal the vial containing solution #4 Voriconazole (Vfend I.V. powder) 0.050 mg/0.1. ml 1. Reconstitute a 200mg vial of voriconazole (Vfend I.V. ®) powder with 19 mL of Preservative-Free Sterile Water for Injection. 2. Withdraw 1 mL of voriconazole solution from step 1 and q.s. to make 20 mL with Preservative-Free Sterile Water for Injection. 3. Transfer the solution from step 2 in 10 mL aliquots to each of 2 sterile empty vials. Seal the vial.

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H.

Preparation of Subconjunctival Antibiotics (Dilutions should be made with non-bacteriostatic sterile water)

Antibiotic Amikacin Ampicillin Clindamycin Cephalothin Cefazolin Ceftazidime Chloramphenicol Gentamicin Methicillin Tobramycin Vancomycin

Amt. in Package 100mg/2 ml 1gm 600mg/4ml 1gm 500mg 500mg 1gm 80mg/2ml 1gm

Vol. Added 0 5ml 0 5ml 2.5ml 2.5ml 5ml 0 5ml

Vol. for Inj. 0.5ml 0.5ml 0.33ml 0.5ml 0.5ml 0.5ml 0.5ml 0.5ml 0.5ml

Dose 25mg 100mg 50mg 100mg 100mg 100mg 100mg 20mg 100mg

80mg/2ml 500 mg

0 5ml

0.5ml 0.25ml

20mg 25mg

I. Preparation of Fortified Topical Antibiotics: 1. Vancomycin (VANCOCIN) 25 mg/ml a. Add 20 ml of 0.9% Sodium Chloride Injection, USP (no preservatives) or Tears Naturale artificial tears to a 500 mg vial of Vancomycin to produce a Solution of 25 mg/ml Vancomycin b. Refrigerate and shake well before instillation 2. Ceftazidime (FORTAZ) 50 mg/ml a. Add 9.2 ml of Tears Naturale to a vial of Ceftazidime 1gm (powder for injection) b. Dissolve. Take 5 ml of this solution and add it to 5 ml of Tears Naturale c. Refrigerate and shake well before instillation 3. Amikacin (AMIKIN) 8 mg/ml a. Add 0.48 ml of Amikacin (500 mg/2 ml) to make a volume with sterile preservative free water of 15 ml b. Refrigerate and shake well before instillation. J. Endophthalmitis Vitrectomy Study (EVS) 1. Purpose: a. To determine the role of immediate 3 port pars plana vitrectomy versus immediate tap/biopsy b. To determine the role of IV antibiotics versus no IV antibiotics

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2. EVS Entry Criteria: a. Clinical diagnosis within 6 weeks of CE or secondary IOL b. Hypopyon or clouding of AC or vitreous media sufficient to obscure clear visualization of second-order retinal arterioles c. The cornea and AC were clear enough to visualize some part of iris. d. The cornea was clear enough to allow the possibility of PPV. e. Visual acuity: worse than 20/50 but at least light perception.



3. EVS Results: a. No difference in final VA or media clarity whether or not systemic antibiotics were employed. b. No difference in outcomes between immediate 3 port PPV vs. tap/biopsy for patients with hand motion or better vision. c. For patients with initial visual acuity of LP only, much better visual results occurred in the immediate 3 port PPV group (versus tap/biopsy group) • 3 times more likely to achieve ≥ 20/40 (33% vs. 11%) • 2 times more likely to achieve ≥ 20/100 (56% vs. 30%) • Less likely to incur 20/40 > 20/100 > 5/200



8.

55% 80% 92%

62% 84% 96%

Microbiology Results Total No. growth/equiv. Coag. (-) micrococci Other gram-positive Gram-negative Polymicrobial

9.

44% 56% 69%

25% 42% 92%

EVS Media Clarity (≥ 20/40) Outcomes by Microbiologic Results vs Initial Treatment N 200 56 94 35 8 7

N = total number of patients

29% 43% 63%

(N = 12) Mixed growth

Vitrectomy n % 179 90 51 91 94 100 22 63 5 63 7 100

N 191 65 90 23 8 5

Tap / Biopsy n 159 58 81 10 6 4

% 83 89 90 44 75 80

n = number achieving ≥ 20/40 view to retina

EVS Outcomes: Causes of VA < 20/40 at Final Follow-up

N = 185 Pigmentary degeneration of the macula Macular edema No apparent cause Macular distortion or preretinal membrane Presumed optic nerve damage Corneal opacity or irregularity Phthisis bulbi or atrophia bulbi Posterior capsular opacity Retinal detachment Macular ischemia Vitreous opacification Other miscellaneous N = total number of patients

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n 33 32 26 15 13 11 13 07 08 06 03 18

% 18 17 14 08 07 06 07 04 04 03 02 10

n = number achieving ≥ 20/40 view to retina

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10. Additional Procedures (ADPROC) (10.5% OR 44/420 EVS Patients) Early ADPROC= within 7 days Late ADPROC= 8 days to 1 year a.

Early ADPROC in each treatment category: • 8% in 3 port PPV group versus 13% in tap/biopsy group • 12% in IV antibiotics group versus 9% no IV antibiotics group. • 86% for worsening ocular inflammation • 14% for complications of the initial procedure

b. Early ADPROC by organisms isolated • Gram (+) coag. negative or no growth 5% • Gram (-) or other gram (+) 30% c. Early ADPROC Recultures performed: 82% • Positive growth 39% • Reculture positive by treatment category (i) Initial 3 port PPV group 13% (ii) Initial tap/biopsy group 71% • Recultures positive by organism isolated (i) Gram (+) coag. neg. (e.g. Staph. epi.) 17% (ii) Gram (+) other (e.g. Streptococci) 40% (iii) Gram (-) organisms (e.g. Serratia) 60%

(36/44) (14/36)

d. Visual acuity outcomes > 20/40 ADPROC= Additional Procedures after Initial Rx ADPROC 15% NO ADPROC 57% 11. Factors associated with higher rates of both gram (-) and other gram (+) organisms: a. Symptom-onset within 2 days of surgery b. Light perception only visual acuity c. Afferent pupillary defect d. Wound abnormalities e. Corneal infiltrate f. Hypopyon > 1.5 mm g. Loss of red reflex h. Eyelid swelling 12. Other EVS Findings a. Diabetes associated with higher yield of coagulase negative staphylococci b. If retinal vessel was visible on initial exam (N = 42), isolates were gram (+), coagulase-negative micrococci or no/equivocal growth c. 40% (85/211) had prep with povidone-iodine at cataract surgery (when information was recorded) d. Ten patients had received antibiotics in the infusion fluid. Harry W. Flynn, Jr., MD presented by:

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13. RD rates: Overall incidence was 8.3% a. LP initial vision (15%) vs > LP vision b. Initial PPV group (7%) vs. Tap/Biopsy group c. Attempted RD repair in 23 of 35 d. VA > 20/40 - No RD (55%) vs. with RD

(05%) (09%) (66%) (26%)

14. Diabetes (58/420 had DM) a. VA > 20/40 outcomes: • non-diabetic 55% • diabetic 39% b. For diabetic patients with better than LP vision at baseline • initial PPV 57% • initial TAP/Biopsy 40%



K. Endophthalmitis Prevention: 1. Selective prophylactic systemic therapy for open globe injuries a. Vancomycin 1 gram IV q 12 hours b. Ceftazidime 1 gram IV q 12 hours (or Gatifloxacin 400 mg IV or po qd) 2. Identify high risk patients before elective surgery a. Chronic Blepharitis b. Lacrimal drainage abnormalities c. Prosthesis in fellow eye d. Active infection elsewhere 3. Preparation of operative field a. Pre-prep in holding room (5% povidone-iodine solution) b. Second 10% povidone-iodine prep immediately before surgery c. Drape to cover lashes and lid margins 4. Use of Prophylactic Antibiotics (controversial) a. Preoperative topical antibiotics – No definitive studies b. Subconjunctival antibiotics at the end of surgery c. Antibiotics in irrigating solution (ESCRS Cefuroxime Study) • Emergence of resistant organisms • Enormous cost for all procedures • Risk of toxicity 5.

Discard old topical medications (esp. glaucoma drops used prior to surgery)

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General References: Brod RD, Flynn HW Jr, Han DP, Miller D. Endophthalmitis: Diagnosis, Clinical Findings and Management. In Spaeth G. (Ed). Ophthalmic Surgery: Principles and Practice, 4th Edition. Elsevier 2012. Ch. 64. 550-560. Packer M, Chang DF, Dewey SH, Little BC, Mamalis N, Oetting TA, Talley-Rostov A, Yoo SH for the ASCRS Cataract Clinical Committee. Prevention, diagnosis, and management of acute postoperative bacterial endophthalmitis. J Cataract Refract Surg 2011; 37:1699–1714. Schwartz SG, Flynn HW Jr., Scott IU. Endophthalmitis: Classification and current management. Expert Rev Ophthalmol 2 (3), 385-396, 2007. Scott IU, Flynn HW Jr. Endophthalmitis: categories, management and prevention. In: Tasman W, Jaeger EA Eds: Duane’s Clinical Ophthalmology, Vol 6, Ch 64. Philadelphia: Lippincott Williams & Wilkins; 2012. Doft BH. Managing infectious endophthalmitis: Results of the Endophthalmitis Vitrectomy Study. American Academy of Ophthalmology (Focal Points: Clinical Modules). San Francisco. Vol 15; No.3, 1997. Flynn HW Jr., Scott IU. Legacy of the Endophthalmitis Vitrectomy Study. Arch Ophthalmol 2008: 126: 559-561. Cataract Surgery: Avinash Pathengay, Stephen G. Schwartz, Harry W. Flynn Jr. and Darlene Miller (2013). Endophthalmitis Following Cataract Surgery: Clinical Features, Treatment and Prophylaxis in Cataract Surgery, Dr. Farhan Zaidi (Ed.), ISBN: 978-953-51-0975-4, InTech, DOI: 10.5772/22751. Available from: http://www.intechopen. com/books/cataract-surgery/endophthalmitis-following-cataract-surgery-clinical-features-treatment-andprophylaxis. Shirodkar AR, Pathengay A, Flynn HW Jr, et al. Delayed vs. Acute-Onset Endophthalmitis after Cataract Surgery. Am J Ophthalmol. 2012 Mar; 153(3):391-398.e2 doi: 10.1016/j.ajo.2011.08.029. Hung JH, Huang YH, Chang TC, Tseng SH, Shih MH, Wu JJ, Huang FC. A cluster of endophthalmitis caused by Mycobacterium abscessus after cataract surgery. J Microbiol Immunol Infect. 2014 Mar 20. pii: S16841182(14)00028-0. doi: 10.1016/j.jmii.2014.02.001 Rachitskaya AV, Reddy AK, Miller D, Davis J, Flynn HW Jr, Smiddy W, Lara W, Lin S, Dubovy S, Albini TA. Prolonged Curvularia Endophthalmitis Due to Organism Sequestration. JAMA Ophthalmol. 2014;132(9):1123-1126. doi:10.1001/jamaophthalmol.2014.1069 Villegas VM, Emanuelli A, Flynn HW Jr, et al. Endophthalmitis Caused by Achromobacter xylosoxidans after Cataract Surgery. RETINA 34:583–586, 2014 2014. Scott IU, Flynn HW Jr., Endophthalmitis: Prevention and Management. In: Han Eds: Cataract Surgery and Retinal Diseases: Optimizing Visual Outcome. bmc, Philadelphia. ISBN: 978-0-615-84030-7, 2013.

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Pathengay A, Flynn HW Jr, Isom RF, Miller D. Endophthalmitis Outbreaks Following Cataract Surgery: Causative Organisms, Etiologies, and Visual Acuity Outcomes. Journal of Cataract and Refractive Surgery (0886-3350)2012 Jul. Vol. 38: (7); 1278-82. Pathengay A, Khera M, Das T, Sharma S, Miller D, Flynn HW Jr. Acute Postoperative Endophthalmitis Following Cataract Surgery: A Review. Asia Pacific Academy of Ophthalmology 12/2011;1(1):35-42. Lalwani GA, Flynn HW Jr, Scott IU, et al. Acute-Onset Endophthalmitis after Clear Corneal Cataract Surgery (1996-2005). Ophthalmology; 115: 473-476, 2008. Endophthalmitis Incidence: Yao K, Zhu Y, Zhu Z, Wu J, Liu Y, Lu Y, Hao Y, Bao Y, Ye J, Huang Y, Li Z, Shentu X, Yu Y. The incidence of postoperative endophthalmitis after cataract surgery in China: a multicenter investigation of 2006-2011. Br J Ophthalmol. 2013 Oct;97(10):1312-7. West ES, Behrens A, McDonnell PJ, et al. The incidence of endophthalmitis after cataract surgery among the U.S. Medicare population increased between 1994 and 2001. Ophthalmology. 2005 Aug; 112(8):1388-94. Wykoff CC, Parrott MB, Flynn HW Jr., Shi W, Miller D, Alfonso EC. Nosocomial acute-onset postoperative endophthalmitis at a university teaching hospital (2002-2009). Am J Ophthalmol 2010; 150: 392-398. Eifrig CW, Scott IU, Flynn HW Jr, Miller D. Acute-onset postoperative endophthalmitis: Review of incidence and visual outcomes. Ophthalmic Surg. Lasers 33: 373-378, 2002. Aaberg TM Jr., Flynn HW Jr, Newton J. Nosocomial acute-onset postoperative endophthalmitis survey: a 10year review of incidence and outcomes. Ophthalmology 105: 1004-1010, 1998. Kattan HM, Flynn HW Jr, Pflugfelder SC, Robertson C, Forster RK. Nosocomial endophthalmitis survery. Current incidence of infection following intraocular surgery. Ophthalmology 98: 227-238, 1991. Ravindran RD, Venkatesh R, Chang DF et al. Incidence of post-cataract endophthalmitis at Aravind Eye Hospital. Outcomes of more than 42000 consecutive cases using standardized sterilization and prophylaxis protocols. J Cataract Refract Surg 2009; 35:629-636. Al-Mezaine HS, Kangave D, Al-Assiri A et al. Acute-onset nosocomial endophthalmitis after cataract surgery. Incidence, clinical features, causative organisms, and visual outcomes. J Cataract Refract Surg 2009; 35: 643649. Miller JJ, Scott IU, Flynn HW Jr. Smiddy WE, Newton J, Miller D. Acute-onset endophthalmitis after cataract surgery (2000-2004): Incidence, clinical settings, and visual acuity outcomes after treatment. Am J Ophthalmol 139:983-987, 2005. Javitt JC, Street DA, Tielsch JM et al. National outcomes of cataract extraction. Retinal detachment and endophthalmitis after outpatient cataract surgery. Ophthalmology 101: 100-106, 1994.

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Keay L, Gower EW, Cassard SD et al. Postcataract Surgery Endophthalmitis in the US. Analysis of Complete 2003 to 2004 Medicare Database of Cataract Surgery. Ophthalmology 2012; 119: 914-922. Endophthalmitis Cultures: Moloney TP, Park J. Microbiological isolates and antibiotic sensitivities in culture-proven endophthalmitis: a 15- year review. Br J Ophthalmol. 2014 Jun 17. Epub ahead of print. Gentile RC, Shukla S, Shah M, Ritterband DC, Engelbert M, Davis A, Hu DN. Microbiological Spectrum and Antibiotic Sensitivity in Endophthalmitis: A 25-Year Review. Ophthalmology. 2014 Aug;121(8):1634-42. doi: 10.1016/j.ophtha.2014.02.001 Schimel AM, Miller D, Flynn HW Jr. Endophthalmitis Isolates and Antibiotic Susceptibilities: A 10-Year Review of Culture-Proven Cases. Am J Ophthalmol. 2013 Jul;156(1):50-52.e1. doi: 10.1016/j.ajo.2013.01.027 Schimel AM, Miller D, Flynn HW Jr., Evolving Fluoroquinolone Resistance Among Coagulase-Negative Staphylococcus Isolates Causing Endophthalmitis. Arch Ophthalmol 2012. 130; 12: 1617-1618 DEC. Benz MS, Scott IU, Flynn HW Jr. Unonius N, Miller D. Endophthalmitis isolates and antibiotic sensitivities: A 6-year review of culture-proven cases. Am J Ophthalmol 137: 38-42, 2004. Donahue SP, Kowalski RP, Jewart BH, Friberg TR. Vitreous cultures in suspected endophthalmitis - Biopsy or vitrectomy? Ophthalmology 100: 452-455, 1993. Speaker MG, Milch FA, Shah MK et al. Role of external bacterial flora in the pathogenesis of acute postoperative endophthalmitis. Ophthalmology 98: 639-650, 1991. Joondeph BC, Flynn HW Jr, Miller DA, Joondeph HC. A new culture method for infectious endophthalmitis. Arch Ophthalmol 107:1334-1337, 1989. Recchia FM, Busbee BG, Pearlman RB, Carvalho-Recchia CA, Ho AC. Changing trends in the microbiologic aspects of postoperative endophthalmitis. Arch Ophthalmol 123: 341-346, 2005. Prophylaxis and Prep for Surgery: Rahman N, Murphy CC. Impact of intracameral cefuroxime on the incidence of postoperative endophthalmitis following cataract surgery in Ireland. Ir J Med Sci. doi 10.1007/s11845-014-1127-y. Rudnisky CJ,Wan D,Weis E. Antibiotic choice for the prophylaxis of post-cataract extraction endophthalmitis. Ophthalmology. 2014 Apr;121(4):835-41. Ahmed Y, Scott IU, Pathengay A, Bawdekar A, and Flynn HW Jr., Editorial: Povidone-Iodine for Endophthalmitis Prophylaxis. Am J Ophthal 2014 Mar; 157(3): 503-4. doi: 10.1016/j.ajo.2013.12.001. Myneni J, Desai SP, Jayamanne DG. Reduction in postoperative endophthalmitis with intracameral cefuroxime. J Hosp Infect. 2013 Aug;84(4):326-8. Harry W. Flynn, Jr., MD presented by:

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Gower EW, Lindsley K, Nanji AA, Leyngold I, McDonnell PJ. Perioperative antibiotics for prevention of acute endophthalmitis after cataract surgery. Cochrane Database Syst Rev. 2013 Jul 15;7:CD006364. Wykoff CC, Flynn HW Jr., Han DP. Allergy to Povidone-Iodine and Cephalosporins: The Clinical Dilemma in Ophthalmic Use. Am J Ophthalmol 2011; 151: 4-6. Miller D, Flynn PM, Scott IU, Flynn HW Jr. In vitro fluoroquinolone resistance in staphylococcal endophthalmitis isolates. Arch Ophthalmol 124: 479-483, 2006. Deramo VA, Lai JC, Fastenberg DM, Udell IJ. Acute endophthalmitis in eyes treated prophylactically with gatifloxacin and moxifloxacin. Am J. Ophthalmol. 142: 721-725, 2006. Ciulla TA, Starr MB, Masket S. Bacterial endophthalmitis prophylaxis for cataract surgery. Ophthalmology 109:13-26, 2002 (See Letters-to-editor, Ophthalmology 110: 1667-1669, 2003). Berrocal AM, Schuman JS. Subconjunctival cephalosporin anaphylaxis. Ophthalmic Surg Lasers 32: 79-80, 2001. Starr MB, Lally JM. Antimicrobial prophylaxis for ophthalmic surgery. Surv. Ophthalmol. 39: 485-501, 1995. Apt L, Isenberg SJ, Yoshimori R, et al: The effect of povidone-iodine solution applied at the conclusion of ophthalmic surgery. Am J Ophthalmol 119: 701-705, 1995. Masket S. The role of antibacterial prophylaxis for cataract surgery (consultation section). J. Cataract Refract Surg. 19: 108-111, 1993. Meredith TA. Prevention of postoperative infection (Editorial) Arch Ophthalmol 109: 944-945, 1991. Apt L. Isenberg SJ, Yoshimori R. et al. Outpatient topical use of povidone-iodine in preparing the eye for surgery. Ophthalmology 96: 289-292, 1989. Antibiotics in the Irrigating Fluid / Intracameral Injection: Schimel AM, Alfonso EC, Flynn HW Jr. Endophthalmitis Prophylaxis for Cataract Surgery, Are Intracameral Antibiotics Necessary? JAMA Ophthalmol online Aug 2014 doi 10.10001/jamaophthalmol.2014.2052. Rudnisky CJ,Wan D,Weis E. Antibiotic choice for the prophylaxis of post-cataract extraction endophthalmitis. Ophthalmology. 2014 Apr;121(4):835-41. Matsuura K, Miyoshi T, Suto C, Akura J, Inoue Y. Efficacy and safety of prophylactic intracameral moxifloxacin injection in Japan. J Cataract Refract Surg. 2013 Nov;39(11):1702-6. Myneni J, Desai SP, Jayamanne DG. Reduction in postoperative endophthalmitis with intracameral cefuroxime. J Hosp Infect. 2013 Aug;84(4):326-8. Garat M, Moser CL, Martin-Baranera M et al. Prophylactic intracameral cefazolin after cataract surgery. Endophthalmitis risk reduction and safety results in a 6-year study. J Cataract Refract Surg 2009; 35: 637-642. Harry W. Flynn, Jr., MD presented by:

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Gupta MS, McKee HDR, Saldaa M, Stewart OG. Macular thickness after cataract surgery with intracameral cefuroxime. J. Cataract Refract Surg, 31: 1163-1166, 2005. Gills JP, Rowsey JJ: Bacterial endophthalmitis prophylaxis (letter to the editor) Ophthalmology 110: 16681669, 2003. Montan PG, Wejde G, Koranyi G, Rylander M. Prophylactic intracameral cefuroxime efficacy in preventing endophthalmitis after cataract surgery. J Cataract Refract Surg. 28: 977-981, 2002. Gordon YJ.Vancomycin prophylaxis and emerging resistance: Are Ophthalmologists the Villains? The Heroes? Am J Ophthalmol 131: 371-376, 2001. Mendivil, A, Mendivil MP. The effect of topical povidone-iodine, intraocular vancomycin or both on aqueous humor cultures at the time of cataract surgery. Am J Ophthalmol 131, 293-300, 2001. Axel-Siegal R, Stiebel-Kalish H, Rosenblatt I, Stressmann E, Yassur Y, Weinberger D. Cystoid macular edema after cataract surgery with intraocular vancomycin. Ophthalmology 106: 1660-1664, 1999. Townsend-PicoWA,Meyers SM,Langston RHS,Costin JA. Coagulase-negative Staphylococcus endophthalmitis after cataract surgery with intraocular vancomycin. Am J Ophthalmol 121: 318-319, 1996. Gritz DC, Cevallos AV, Smolin G, Whitcher JP. Antibiotic supplementation of intraocular irrigating solutions. An in vitro model of antibacterial action. Ophthalmology 103: 1204-1209, 1996. Alfonso EC, Flynn HW Jr. Controversies in endophthalmitis prevention. The risk for emerging resistance to vancomycin. Arch Ophthalmol 113: 1369-1370, 1995. Gills JP: Filters and antibiotics in irrigating solution for cataract surgery. J. Cataract Refract Surg 17: 385-390, 1991. Packer M, Chang DF, Dewey SH, Little BC, Mamalis N, Oetting TA, Talley-Rostov A, Yoo SH for the ASCRS Cataract Clinical Committee. Prevention, diagnosis, and management of acute postoperative bacterial endophthalmitis. Cataract Refract Surg 2011; 37:1699–1714. O’Brien TP, Arshinoff SA, Mah FS. Perspectives on antibiotics for postoperative endophthalmitis prophylaxis: Potential role of moxifloxacin. J Cataract Refract Surg 2007; 33: (10)1790-1800. Nentwich MM, Ta CN, Kreutzer TC et al. Incidence of postoperative endophthalmitis from 1990 to 2009 using povidone-iodine but no intracameral antibiotics at a single academic institution. J Cataract Refract Surg 2015; 41: 58-66. Tan CS, Goh AG, Ngo WK et al. Safety of intracameral antibiotic use after cataract surgery. J Cataract Refract Surg. 2014 Nov;40(11):1940-1. doi: 10.1016/j.jcrs.2014.09.028.

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ESCRS: Barry P. Adoption of intracameral antibiotic prophylaxis of endophthalmitis following cataract surgery: update on the ESCRS Endophthalmitis Study. J Cataract Refract Surg. 2014 Jan;40(1):138-42. Beselga D, Campos A, Castro M, Fernandes C, Carvalheira F, Campos S, Mendes S, Neves A, Campos J, Violante L, Sousa JC. Postcataract surgery endophthalmitis after introduction of the ESCRS protocol: a 5-year study. Eur J Ophthalmol. 2014 Jun 23;24(4):516-9. Behndig A, Cochener B, Güell JL, Kodjikian L, Mencucci R, Nuijts RM, Pleyer U, Rosen P, Szaflik JP, Tassignon MJ. Endophthalmitis prophylaxis in cataract surgery: overview of current practice patterns in 9 European countries. J Cataract Refract Surg. 2013 Sep;39(9):1421-31. García-Sáenz MC,Arias-Puente A,Rodríguez-Caravaca G,Bañuelos JB.Effectiveness of intracameral cefuroxime in preventing endophthalmitis after cataract surgery Ten-year comparative study. J Cataract Refract Surg. 2010; 36(2):203-7. Chang DF, Braga-Mele R, Mamalis N, Masket S, Miller KM, Nichamin LD, Packard RB, Packer M; ASCRS Cataract Clinical Committee. Prophylaxis of postoperative endophthalmitis after cataract surgery: results of the 2007 ASCRS member survey. J Cataract Refract Surg. 2008; 34(4): 531-2; author reply 532-3. Endophthalmitis ESCRS Study Group. Prophylaxis of postoperative endophthalmitis following cataract surgery: results of the ESCRS multicenter study and identification of risk factors. J Cataract Refract Surg. 2007 Jun; 33(6):978-88. Seal DV, Barry P, Gettinby G, Lees F, Peterson M, Revie CW, Wilhelmus KR, ESCRS Endophthalmitis Study Group. ESCRS study of prophylaxis of postoperative endophthalmitis after cataract surgery: Case for a European multicenter study. J Cataract Refract Surg. 2006; 32(3): 396-406. Erratum in: J Cataract Refract Surg. 2006; 32(5): 709. Barry P, Seal DV, Gettinby G, Lees F, Peterson M, Revie CW, ESCRS Endophthalmitis Study Group. ESCRS study of prophylaxis of postoperative endophthalmitis after cataract surgery: Preliminary report of principal results from a European multicenter study. J Cataract Refract Surg. 2006; 32(3): 407-10. Erratum in: J Cataract Refract Surg. 2006; 32(5): 709. Bohigian,GM, Letter: ESCRS study of endophthalmitis prophylaxis Journal of Cataracts & Refractive Surgery, 2006; 32(9)1406-1407. Peter Barry. Reply: ESCRS study of endophthalmitis prophylaxis Journal of Cataract & Refractive Surgery, Volume 32, Issue 9, September 2006;32 (9)1407. Endophthalmitis Organisms and Outcomes: Chhablani J,Sudhalkar A,Jindal A,DasTaraprasad,Motukupally SR, Pathengay A,Flynn HW Jr.Stenotrophomonas maltophilia Endogenous Endophthalmitis: Clinical Presentation,Antibiotic Suceptibility , and Outcomes. Clinical Ophthalmology 2014:8 1523-1526.

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Kuriyan AE, Sridhar J, Flynn HW JR. et al. Endophthalmitis Caused by Enterococcus Faecalis:Clinical Features, Antibiotic Sensitivities and Outcomes. Am J Ophthalmol 2014. Doi:10.1016/j.ajo.2014.07.038. Kuriyan AE, Weiss KD, Flynn HW Jr., Smiddy WE et al. Endophthalmitis Caused by Streptococcal Species: Clinical Settings, Microbiology, Management and Outcomes. Am J Ophthalmol 2014; 157: 774–780. Gentile RC, Shukla S, Shah M, Ritterband DC, Engelbert M, Davis A, Hu DN. Microbiological Spectrum and Antibiotic Sensitivity in Endophthalmitis: A 25-Year Review. Ophthalmology. 2014 Aug;121(8):1634-42. doi: 10.1016/j.ophtha.2014.02.001 Khera M, Pathengay A, Jindal A, Jalali S, Mathai A, Reddy Pappuru R, Relhan N, Das S, Sharma S, Flynn HW Jr. Vancomycin-Resistant Gram-Positive Bacterial Endophthalmitis: Epidemiology, Treatment Options, and Outcomes. J Ophthalmic Inflamm Infect. 2013 Apr 22;3(1):46. doi: 10.1186/1869-5760-3-46. Bispo PJ, Alfonso EC, Flynn HW Jr. and Miller D. Emerging 8-Methoxyfluoroquinolone Resistance Among Methicillin-Susceptible Staphylococcus Epidermidis Isolates Recovered from Patients with Endophthalmitis. J. Clin. Microbiol. 2013, 51(9): 2959-2963. doi: 10.1128/JCM.00846-13. Rachitskaya A,Flynn HW Jr., Wong J, et al. A 10-Year Study of Membrane Filter System Versus Blood Culture Bottles in Culturing Vitrectomy Cassette Vitreous in Infectious Endophthalmitis. Am J Ophthalmol. 2013; 156: 349-354. Miller JJ, Scott IU, Flynn HW Jr., Smiddy WE, Murray TG, Berrocal A, Miller D. Endophthalmitis Caused by Bacillus Species. Am J Ophthalmol 2008; 145: 883-888. Miller DM,Vedula AS, Flynn HW Jr., Miller D, Scott IU, Smiddy WE, MurrayTG,Venkatraman A. Endophthalmitis caused by Staphylococcus epidermidis. In Vitro Antibiotic Susceptibilities and Clinical Outcomes. Ophthalmic Surg Lasers Imaging 2007; 38:446-451. Yoder DM,Scott IU,Flynn HW Jr,Miller D. Endophthalmitis caused by Haemophilus influenzae. Ophthalmology 2004; 11: 2023-2036. Miller JJ, Scott IU, Flynn HW Jr., et al. Endophthalmitis caused by Streptococcus pneumonia. Am J Ophthalmol 138: 231-236, 2004. Scott IU, Loo RH, Flynn HW Jr, Miller D. Endophthalmitis caused by Enterococcus faecalis. Ophthalmology 110: 1573-1577, 2003. Cohen SM, Flynn HW Jr, Miller D. Endophthalmitis caused by Serratia marcescens. Ophthalmic Surgery 28: 195-200, 1997. Mao LK, Flynn HW Jr, Miller DA, Pflugfelder SC. Endophthalmitis caused by Staphylococcus aureus. Am J Ophthalmol 116: 584-589, 1993. Irvine WD, Flynn HW Jr, Miller DA, Pflugfelder SC. Endophthalmitis caused by gram-negative organisms. Arch. Ophthalmol 110: 1450-1454, 1992.

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Mao LK, Flynn HW Jr, Miller D, Pflugfelder SC. Endophthalmitis caused by Streptococcal species. Arch Ophthalmol 110: 798-801, 1992. Vahey J, Flynn HW Jr: Bacillus endophthalmitis. Ophthalmic Surgery 22(11): 681-686, 1991. Brod RD, Flynn HW Jr, Clarkson JG, Pflugfelder SC, Culbertson WW, Miller DA. Endogenous Candida endophthalmitis. Ophthalmology 97: 666-674, 1990. Davis JL, Koidou A, Pflugfelder SC, Miller D, Flynn HW Jr, Forster RK. Coagulase-negative Staphylococcal endophthalmitis. Ophthalmology 95: 1404-1410, 1988. Chang JS, Flynn HW Jr., Miller D. et al. Stenotrophomonas maltophilia Endophthalmitis Following Cataract Surgery: Clinical and Microbiological Results. Clinical Ophthalmology: 2013:7; 771-777. Exogenous Fungal Endophthalmitis: Vilela RC, Vilela L, Vilela P, Vilela R, Motta R, Pôssa AP, de Almeida C, Mendoza L. Etiological agents of fungal endophthalmitis: diagnosis and management. Int Ophthalmol. 2014 Jun;34(3):707-21. Buchta V, Feuermannová A, Váša M, Bašková L, Kutová R, Kubátová A, Vejsová M. Outbreak of fungal endophthalmitis due to Fusarium oxysporum following cataract surgery. Mycopathologia. 2014 Feb;177(12):115-21. Schwartz SG, Davis JL, Flynn HW Jr., Exogenous Endophthalmitis. In: Intraocular Inflammation, M Zierhut, S Ohno, F Orefice, C Pavesio, NA Rao eds. New York: Springer, Avai 10-29-2013. McMillan BD, Miller GJ, Nguyen J. Rare case of exogenous Candida dubliniensis endophthalmitis: a case report and brief review of the literature. J Ophthalmic Inflamm Infect. 2014 May 2;4:11. Wykoff CC, Flynn HW Jr., Scott IU, Alfonso EC. Exogenous Fungal Endophthalmitis: Microbiology and Clinical Outcomes. Ophthalmology. 2008; 115(9): 1501-1507. Gregori NZ, Flynn HW Jr., Miller D, Scott IU, Davis JL, Murray TG,Williams B Jr., Clinical features, management strategies and visual acuity outcomes of Candida endophthalmitis following cataract surgery. Ophthalmic Surg Lasers Imaging 2007; 38: 278-385. Callanan D, Scott IU, Murray TG, Oxford KW, Bowman CB, Flynn HW Jr. Early onset endophthalmitis caused by Aspergillus species following cataract surgery. Am J Ophthalmol 2006; 142:509-511. Hariprasad SM, Mieler WF, Holz ER, et al. Determination of vitreous, aqueous, and plasma concentration of orally administered voriconazole in humans. Arch Ophthalmol 122:42-47, 2004. Gao H, Pennesi ME, Shah K, et al. Intravitreal voriconazole. An electro- retinographic and histologic study. Arch Ophthalmol 122: 1687-1692, 2004.

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Scott IU, Flynn HW Jr. Miller D, Speights JW, Snip RC, Brod RD. Exogenous endophthalmitis caused by amphotericin B-resistant Paecilomyces lilacinus: Treatment options and visual outcomes. Arch Ophthalmol 119: 916-919, 2001. Narang S, Gupta A, Gupta V et al. Fungal endophthalmitis following cataract surgery: Clinical presentation, microbiological spectrum and outcome. Am J Ophthalmol 132: 609-617, 2001. Reis A, Sundmacher R,Tintelnot K, et al. Successful treatment of ocular invasive mold infection with voriconazole. Br J Ophthalmol 84: 932-933, 2000. Pflugfelder SC, Flynn HW Jr, Zwickey TA, et al. Exogenous fungal endophthalmitis. Ophthalmology 95: 1930, 1988. Endophthalmitis / Trauma: Jindal A, Pathengay A, Mithal K, Jalali S, Mathai A, Pappuru RR, Narayanan R, Chhablani J, Motukupally SR, Sharma S, Das T, Flynn HW Jr. Endophthalmitis After Open Globe Injuries: Changes in Microbiological Spectrum and Isolate Susceptibility Patterns Over 14 Years. Journal of Ophthalmic Inflammation and Infection 2014, 4:5. http//www.joii-journal.com/content/4/1/5. Long C, Liu B, Xu C, Jing Y,Yuan Z, Lin X. Causative organisms of post-traumatic endophthalmitis: a 20-year retrospective study. BMC Ophthalmol. 2014 Mar 25;14:34. AhmedY, Schimel AM, Pathengay A, Colyer MH, Flynn HW Jr., Endophthalmitis Following Open Globe Injuries. EYE 2012:Vol 26 (2), 212-7. DOI: 10.1038/eye.2011.313. Jacobs DJ, Grube TJ, Flynn HW Jr. et al. Inravitreal Moxifloxacin in the Management of Ochrobactrum intermedium Endophthalmitis due to Metallic Intraocular Foreign Body. Clinical Mol Ophthalmol 2013:7;17271730. Parke DW III, Pathengay A, Flynn HW Jr, Albini T. Risk factors for endophthalmitis and retinal detachment with retained intraocular foreign bodies. J Ophthalmol 2012 (2012) 758526. doi:10.1155/2012/758526. Andreoli MT, Andreoli CM. Surgical rehabilitation of the open globe injury patient Am J Ophthalmol. 2012 May; 153(5):856-60. Cebulla CM, Flynn HW Jr., Endophthalmitis after Open Globe Injuries. (Editorial). Am J Ophthalmol 2009; 147: 567-568. Lieb DF, Scott IU, Flynn HW Jr. et al. Open globe injuries with positive intraocular cultures. Factors influencing final visual acuity outcomes. Ophthalmology 110: 1560-1566, 2003. Reynolds DG, Flynn HW Jr. Endophthalmitis after penetrating ocular trauma. Current Opinion in Ophthalmology; 8: 32-38, 1997. Foster RE, Martinez JA, Murray TG, Rubsamen PE, Flynn HW Jr, Forster RK. Useful visual outcomes after treatment of Bacillus cereus endophthalmitis. Ophthalmology 103: 390-397, 1996. Harry W. Flynn, Jr., MD presented by:

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Thompson WS, Rubsamen PE, Flynn HW Jr, Schiffman J, Cousins SW. Endophthalmitis following penetrating trauma: Risk factors and visual acuity outcomes. Ophthalmology 102: 1696-1701, 1995. Ariyasu RG, Kumar S, La Bree LD, Wagner DG, Smith RE. Microorganisms cultured from the anterior chamber of ruptured globes at the time or repair. Am J Ophthalmol 119: 181-188, 1995. Verbraeken H, Rysselaere M: Post-traumatic endophthalmitis. Eur J Ophthalmol 4: 1-5, 1994. Thompson JT, Parver LM, Enger C, Mieler WF, Liggett PE and the NETS. Endophthalmitis after penetrating ocular injuries with retained intraocular foreign bodies. Ophthalmology 100: 1468-1474, 1993. Yoshizumi MO, Leinwand MJ, Kim J.Topical and intravenous gentamicin in traumatically lacerated eye. Graefe Arch Clin Exp Ophthalmol 230: 175-177, 1992. Kervick GN, Flynn HW Jr,Alfonso E, Miller D. Antibiotic therapy for Bacillus species infections.Am J Ophthalmol 110: 683-687,1990. Mieler WF, Ellis MK, Williams DF, Han DP. Retained intraocular foreign bodies and endophthalmitis. Ophthalmology 97: 1532-1538, 1990. Boldt HC, Pulido JS, Blodi CF, Folk JC, Weingeist TA. Rural endophthalmitis. Ophthalmology 967: 1722-1726, 1989. Williams DR, Mieler WF, Abrams GW, Lewis H. Results and prognostic factors in penetrating ocular injuries with retained intraocular foreign bodies. Ophthalmology 95: 911-916, 1988. Affeldt JC, Flynn HW Jr, Forster RK, Mandelbaum S, Clarkson JG, Jarus GD. Microbial endophthalmitis resulting from ocular trauma. Ophthalmology 94: 407-413, 1987. Brinton GS, Topping TM, Hyndiuk RA, Aaberg TM, Reeser FH, Abrams GW. Post-traumatic endophthalmitis. Arch Ophthalmol 102: 547-550, 1984. Barr CC. Prognosis factors in corneoscleral lacerations. Arch Ophthalmol 101: 919-924, 1983. Delayed-onset Pseudophakic Endophthalmitis: Javey G, Albini TA, Flynn HW Jr. Resolution of Pigmented Keratic Precipitates Following Treatment of Pseudophakic Endophthalmitis Caused by Propionibacterium Acnes. Ophthalmic Surg Lasers Imaging. 2010 Mar 9:1-3. Shirodkar AR, Pathengay A, Flynn HW Jr, et al. Delayed vs. Acute-Onset Endophthalmitis after Cataract Surgery. Am J Ophthalmol. 2012 Mar; 153(3):391-398.e2. Al-Mezaine HS, Al-Assiri A, Al-Rajhi AA. Incidence, clinical features, causative organisms, and visual outcomes of delayed-onset pseudophakic endophthalmitis. Eur J Ophthalmol. 2009 Sep-Oct;19(5):804-11.

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Jones JB. Postoperative P. acnes endophthalmitis. Ophthalmology 108: 633, 2001. Chaudhry N, Flynn HW Jr, Smiddy WE, Miller D. Xanthomonas maltophilia endophthalmitis after cataract surgery. Arch Ophthalmol 118: 572-575, 2000. ClarkWL, Kaiser PK, Flynn HW Jr et al.Treatment strategies and visual acuity outcomes in chronic postoperative P. acnes endophthalmitis. Ophthalmology 106: 1665-1670, 1999. Aldave AJ. Stein JD, Deramo VA et al. Treatment strategies for postoperative P. acnes endophthalmitis. Ophthalmology 1999; 106: 2395-401. AabergTM Jr, Rubsamen PE, Joondeph BC, Flynn HW Jr. Chronic postoperative gram negative endophthalmitis. Retina 17: 260-262, 1997. Winward KE,Pflugfelder SC,Flynn HW Jr,RousellTJ,Davis JL. Postoperative Propionibacterium Endophthalmitis. Treatment strategies and long-term results. Ophthalmology 100:447-451, 1993. Owens SL, Lam S, Tessler HH, Deutsch TA: Preliminary study of a new intraocular method in the diagnosis and treatment of P. acnes endophthalmitis. Ophthalmic Surgery 24: 268-72, 1993. Fox GM, Joondeph BC, Flynn HW Jr, Pflugfelder SC, RousselTJ. Delayed-onset pseudophakic endophthalmitis. Am J Ophthalmol 1991; 111: 163-173. Ficker L, Meredith TA,Wilson LA, Kaplan HJ, Kozarsky AM. Chronic bacterial endophthalmitis. Am J Ophthalmol. 103: 745-749, 1987. Meisler DM, Palestine AG,Vastine DW, Demartini DR, Murphy BF, Reinhart WJ, Zakov ZN, McMahon JT, Cliffel TP. Chronic Propionibacterium endophthalmitis after extracapsular cataract extraction and intraocular lens implantation. Am J. Ophthalmol 102: 733, 1986. Stern WH, Tamura E. Jacobs RA, Pons VG, Stone RD, O’Day, Irvine AR. Epidemic postsurgical Candida parapsilosis endophthalmitis, clinical findings and management of 15 consecutive cases. Ophthalmology 92: 1701, 1985. Delayed-onset Endophthalmitis Associated With Filtering Blebs / Blebitis: Brillat-Zaratzian E, Bron A, Aptel F, Romanet JP, Cornut PL, Vandenesch F, Boisset S, Maurin M, Chiquet C. FRIENDS Group: clinical and microbiological characteristics of post-filtering surgery endophthalmitis. Graefes Arch Clin Exp Ophthalmol. 2014 Jan;252(1):101-7. Jacobs DJ, Pathengay A, Flynn HW Jr., Leng T, Miller D, and Shi W. Intravitreal Dexamethasone in the Management of Delayed-Onset Bleb-Associated Endophthalmitis, International Journal of Inflammation, vol. 2012, Article ID 503912, 5 pages, 2012. Jacobs DJ, Leng T, Flynn HW Jr. et al. Delayed-Onset Bleb-Associated Endophthalmitis: Presentation and Outcome by Culture Result. Clinical Ophthalmology 2011; 5: 1-6.

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Leng T, Miller D, Flynn HW Jr, Jacobs DJ, Gedde SJ. Delayed-Onset Bleb-Associated Endophthalmitis (19962008); Causative Organisms and Visual Acuity Outcomes. Retina 31:344-352, 2011. Song AA, Scott IU, Flynn HW Jr, et al. Delayed-onset bleb-associated endophthalmitis. Ophthalmology 109:985-991, 2002. Kangas TA, Greenfield DS, Flynn HW Jr. Delayed onset endophthalmitis associated with conjunctival filtering blebs. Ophthalmology 104: 746-752, 1997. Phillips WB, Wong TP, Berger RL, Friedberg MA, Benson WE. Late-onset endophthalmitis associated with filtering blebs. Ophthal. Surg 25: 88-91, 1994. Brown RH, Yang LH, Walker SD et al. Treatment of bleb infection after glaucoma surgery. Arch Ophthalmol 112: 57-61, 1994. Wolner B, Liebmann JM, Sassani JW, Ritch R, Speaker M, Mamor M. Late bleb-related endophthalmitis after trabeculectomy with adjunctive 5-fluorouracil. Ophthalmology 98: 1053-1060, 1991. Mandelbaum S. Forster RK, Gelender H, Culbertson W. Late onset endophthalmitis associated with filtering blebs. Ophthalmology 92: 964-972, 1985. Katz LJ, Cantor LB, Spaeth GL, Complications of surgery in glaucoma. Early and later bacterial endophthalmitis following glaucoma filtering surgery. Ophthlamology 92: 959-963, 1985. Endophthalmitis Associated with Glaucoma Drainage Devices: Gedde SJ, Scott IU, Homayoun T, Kevin K, Luu M, Budenz DL, Greenfield DS, Flynn HW Jr. Late endophthalmitis associated with glaucoma drainage implants. Arch Ophthalmology 108: 1-5, 2001. Stewart MW, Bolling JP, Bendel RE. Nocardia brasiliensis endophthalmitis in a patient with an exposed Ahmed glaucoma drainage implant. Ocul Immunol Inflamm. 2013;21(1):69-70. Ahmed Y, Pathengay A, Flynn HW Jr, et al. Delayed-Onset Endophthalmitis Associated with Ex-PRESS Mini Glaucoma Shunt®. Ophthalmic Surgery Lasers & Imaging 2012; 43: e62-e63. doi: 10.3928/1542887720120705-01. Endogenous Endophthalmitis: Sridhar J, Flynn HW Jr, Kuriyan AE, Dubovy S, Miller D. Endophthalmitis caused by Klebsiella species. Retina. 2014. Epub ahead of print. Adam CR, Sigler EJ. Multimodal Imaging Findings in Endogenous Aspergillus Endophthalmitis. Retina. 2014 Apr 1. Epub ahead of print. Wu Z, Huang J, Huynh S, Sadda S. Bilateral endogenous endophthalmitis secondary to group B streptococcal sepsis. Chin Med J (Engl). 2014 May;127(10):1999. Harry W. Flynn, Jr., MD presented by:

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Sridhar J, Flynn HW Jr., Kuriyan AE et al. Endogenous Fungal Endophthalmitis: Risk Factors, Clinical Features, and Treatment Outcomes in Mold and Yeast Infections. Journal of Ophthalmic Inflammation and Infection 2013, 3:60. http://www.joii-journal.con/content/3/1/60. Lingapan A, Wykoff CC, Albini TA, Miller D, Pathengay A. Endogenous Fungal Endophthalmitis: Causative Organisms, Management Strategies and Visual Acuity Outcomes. Am J Ophthalmol 2012: 153; 162–166. Schiedler V, Scott IU, Flynn HW Jr et al. Culture-proven endogenous endophthalmitis: clinical features and visual acuity outcomes. Am J Ophthalmol 137: 725-731, 2004. Flynn HW Jr. The clinical challenge of endogenous endophthalmitis. Retina 21: 572-574, 2001. Harris EW, D’Amico DJ, Bhisitkul R. et al. Bacterial subretinal abscess: A case report and review of the literature. Am J. Ophthalmol. 129: 778-785, 2000. Brod RD, Flynn HW Jr, Miller D. Endogenous fungal endophthalmitis. In Tasman W, Jaeger E. (eds.) Duane’s Clinical Ophthalmology CV Mosby, St. Louis, Chapter 11, Vol 3: 2000, 1-40. Gupta A, Gupta V, Dogna MR et al. Fungal endophthalmitis after a single intravenous administration of presumably contaminated dextrose infusion fluid. Retina 20: 262-268, 2000. LaKasha H, Pavlin CJ, Lipton J. Subretinal abscess due to Nocardia farcinica infection. Retina 20: 269-274, 2000. Wong JS, Chan TK, Lee HM, Chee SP. Endogenous bacterial endophthalmitis. Ophthalmology 107: 14831491, 2000. Weishaar PD, Flynn HW Jr, Murray TG, et. al. Endogenous Aspergillus Endophthalmitis: Clinical Features and treatment outcomes. Ophthalmology 105: 57-65, 1998. Essman TF, Flynn HW Jr, Smiddy WE, Brod RD, Murray TG, Davis JL, Rubsamen PE. Endogenous fungal endophthalmitis: Treatment outcomes in a ten-year study. Ophthalmic Surgery 28: 185-194, 1997. Okada AA, Johnson RP, Liles C, D’Amico DJ, Baker AS. Endogenous bacterial endophthalmitis. Ophthalmol 101: 832-838, 1994. Menezes AV, Sigesmund DA, Demajo WA, Devenyi RG. Mortality of hospitalized patients with Candida endophthalmitis. Arch Intern Med. 154: 2093-7, 1994. Greenwald MJ, Wohl LG, Sell CH. Metastatic bacterial endophthalmitis. A contemporary reappraisal. Surv Ophthalmol 31: 81-101, 1986.

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Experimental Endophthalmitis: Chio S, Hahn TW, Osterhout G, O’Brien TP. Comparative intravitreal antibiotic therapy for experimental Enterococcus faecalis endophthalmitis. Arch Ophthalmol 114: 61-65, 1996. Alfaro DV, Hudson SJ, Rafanan MM et. al. The effect of trauma on the ocular penetration of intravenous ciprofloxacin. Am J Ophthalmol 122: 678-683, 1996. El-Massry A, MeredithTA,Aguilar HE, et. al. Aminoglycoside levels in the rabbit vitreous cavity after intravenous administration. Am J Ophthalmol 122: 684-689, 1996. Meredith TA, Aguilar HE, Shaarawy A, et al. Vancomycin levels in the vitreous cavity after intravenous administration. Am J Ophthalmol 119: 774-778, 1995. Meredith TA: Antimicrobial pharmacokinetics in endophthalmitis treatment. Studies of ceftazidime. Trans Am Ophthalmol Soc 91: 653, 1993. Stern GA: Factors affecting the efficacy of antibiotics in the treatment of experimental postoperative endophthalmitis. Trans Am Ophthalmol Soc. 91: 775, 1993. Forster, RK. Experimental postoperative endophthalmitis. Tr. Am Ophth Soc.Vol 90, 505-559. 1992. MeredithTA,Aguilar HE, Miller MJ, Gardner SK,Trabelski A,Wilson LA. Comparative treatment of experimental Staphylococcus epidermidis endophthalmitis. Arch Ophthalmol 108: 857-860, 1990. Talley AR, D’Amico DJ,Talamo JH, CaseyVJ, Kenyon KR.The role of vitrectomy in the treatment of postoperative bacterial endophthalmitis. An experimental study. Arch Ophthalmol 105: 1699-1702;, 1987. Early Large Clinical Series: Phillips WB,Tasman WS. Postoperative endophthalmitis in association with diabetes mellitus. Ophthalmology 101: 508-518, 1994. Stonecipher KG, Ainbinder DI, Maxwell DP, Diamond JG, Caldwell DR. Infectious endophthalmitis: A review of 100 cases. Ann Ophthalmol Glaucoma 26: 108-115, 1994. Bohigian GM, Olk RJ. Factors associated with a poor visual result in endophthalmitis. Am J Ophthalmol 101: 332-334, 1986. Driebe WT Jr, Mandelbaum S, Forster RK, et al. Pseudophakic endophthalmitis: Diagnosis and management. Ophthalmology 93: 442-448, 1986. Puliafito CA, Baker AS, Haaf J, Foster CS. Infectious endophthalmitis. Ophthalmology 89: 921-929, 1982. Rowsey JJ, Newson DL, Sexton DJ, Harms WK. Endophthalmitis: Current approaches. Ophthalmology 89: 1055-1066, 1982.

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Diamond JG. Intraocular management of endophthalmitis. Arch Ophthalmol 99: 96-99, 1981. Endophthalmitis Treatment with Intravitreal / Periocular / Systemic Steroids: Roth DB, Modi KK Scott IU, Flynn HW Jr., Update on the Use of Intraocular Steroids for Posterior-Segment Diseases. More Choices Exist than Ever Before, but Complications Persist as Well. Retinal Physician 2013 Vol 10, No 7; 49-53, 62-63. Jacobs DJ, Pathengay A, Flynn HW Jr., Intravitreal Dexamethasone in the Management of Delayed-Onset Bleb-Associated Endophthalmitis, International Journal of Inflammation, vol. 2012 doi:10.1155/2012/503912. Liu SM, Way T, Rodrigues M, Scott M, Steidl, SM. Effects of Intravitreal corticosteroids in the treatment of Bacillus cereus endophthalmitis. Ophthalmol 118: 803-806.2011. Harris MJ. Visual outcome after intravitreal steroid use for postoperative endophthalmitis. Ophthalmology 108: 240-241, 2001. Shah GJ, Stein JD, Sharma S, Sivalingam A, Benson WE, Regillo CD, Brown GC, Tasman W. Visual outcomes following the use of intravitreal steroids in the treatment of postoperative endophthalmitis. Ophthalmology; 107: 486-489. 2000. Das T, Jalali S, Gothwal VK, Sharma S, Naduvilath TJ. Intravitreal dexamethasone in exogenous bacterial endophthalmitis: results of a prospective randomized study. Br J Ophthalmol 83: 1050-1055, 1999. Yoshizumi MO, Lee GC, Egui RA et al. Timing of dexamethasone treatment in experimental Staphylococcus aureus endophthalmitis. Retina 18: 130-135, 1998. Weijtens O, Vander Sluijs FA, Schoemaker RC et al. Peribulbar corticosteroid injection: vitreal and serum concentration after dexamethasone disodium phosphate injection. Am J Ophthalmol 123: 358-363, 1997. Park SS, Samig N, Ruoff K, D’Amico DJ, Baker AS. Effect of intravitreal dexamethasone in the treatment of pneumococcal endophthalmitis in rabbits. Arch Ophthalmol. 113: 1324-1329, 1995. Coats ML, Peyman GA. Intravitreal corticosteroids in the treatment of exogenous fungal endophthalmitis. Retina 12: 46-51, 1992. Kwak HW, D’Amico DJ. Evaluation of the retinal toxicity and pharmokinetics of dexamethasone sodium phosphate after intravitreal injection. Arch Ophthalmol. 110: 259-266, 1992. Maxwell DP, Brent DB, Diamond JG, WUL: Effect of intravitreal dexamethasone on ocular histopathology in a rabbit model of endophthalmitis. Ophthalmology 98: 1370-1375, 1991. Peyman GA, Herbst R. Bacterial endophthalmitis: treatment with intraocular injection of gentamicin and dexamethasone. Arch Ophthalmol. 91: 416-418, 1974.

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Miscellaneous: Townsend J, Pathengay A, Flynn HW Jr., Miller D. Management of Endophthalmitis While Preserving the Uninvolved Crystalline Lens. Clinical Ophthalmology 2012: 6; 453-457. Nguyen JK, Fung AE, Flynn HW Jr, Scott IU. Hypopyon and pseudoendophthalmitis associated with chronic vitreous hemorrhage. Ophthalmic Surg Lasers Imaging 37: 317-319, 2006. Sulkes DJ, Flynn HW Jr, Scott IU, Feuer WJ, Christmas J. Evaluating outpatient versus inpatient costs in endophthalmitis management. Retina 22: 747-751, 2002. Jones DB. Emerging antibiotic resistance: real and relative. Arch Ophthalmol 114: 91-92, 1996. Kim JE, Flynn HW Jr, Rubsamen PE, Murray TG, Davis JL, Smiddy WE. Endophthalmitis in patients with retained lens fragments after phacoemulsification. Ophthalmology 103: 575-578, 1996. Scott IU, Flynn HW Jr, Feuer W. Endophthalmitis after secondary IOL implantation: a case/control study. Ophthalmology 102; 1925-1931, 1995. Foster RE, Rubsamen PE, Joondeph BC, Flynn HW, Smiddy WS: Concurrent endophthalmitis and retinal detachment. Ophthalmology 101:490-498, 1994. Ormerod LD, Puklin JE, McHenry JG, McDermott ML. Scleral flap necrosis and infectious endophthalmitis after cataract surgery with a scleral tunnel incision. Ophthalmology 100: 159-163, 1993. Monson MC, Mamalis N, Olson RJ,Toxic anterior segment inflammation following cataract surgery. J. Cataract Refract Surg. 18; 184-189, 1992. Irvine WD, Flynn HW Jr, Murray TG, Rubsamen PE. Retained lens fragments after phacoemulsification manifesting as marked intraocular inflammation with hypopyon. Am J Ophthalmol 114: 610-614, 1992. Huang S, Brod R, Flynn HW Jr. Endophthalmitis management while preserving the uninvolved crystalline lens. Am J Ophthalmol 112: 695-701, 1991. Stonecipher KG, Parmley VC, Jensen H, Rowsey JJ. Infectious endophthalmitis following sutureless cataract surgery. Arch Ophthalmol 109: 1562-1563, 1991. TASS: Arslan OS, Tunc Z, Ucar D, Seckin I, Cicik E, Kalem H, Sencan S, Hepokur M. Histologic Findings of Corneal Buttons in Decompensated Corneas WithToxic Anterior Segment Syndrome After Cataract Surgery. Cornea. October 2013 - Volume 32 - Issue 10 - p 1387–1390 doi: 10.1097/ICO.0b013e3182a0d030

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Gottsch JD, Schein OD.Taking TASS to Task. Ophthalmol 2012: 119; 7, 1295-1296. Eydelman MB, Tarver ME, Calogero D, et al. The Food and Drug Administration’s Proactive Toxic Anterior Segment Syndrome Program. Ophthalmol 2012: 119; 7, 1297-1302. Mamalis N.Toxic anterior segment update [Editorial]. J Cataract Refract Surg 2010; 36: 1067-1068. American Society of Cataract and Refractive Surgery and the American Society of Ophthalmic Registered Nurses. Recommended practices for cleaning and sterilizing intraocular surgical instruments. J Cataract Refract Surg 2007; 33: 1095-1100. Mamalis N, Edelhauser HF, Dawson DG, Chew J, LeBoyer RM, Werner L.Toxic anterior segment syndrome. J Cataract Refractive Surg 2006; 32: 324-333. Mamalis N.Toxic anterior segment syndrome [Editorial]. J Cataract Refract Surg 2006; 32: 181-182. The Endophthalmitis Vitrectomy Study: Flynn HW Jr., Scott IU. Legacy of the Endophthalmitis Vitrectomy Study. Arch Ophthalmol 2008: 126: 559-561. Doft BD, Wisniewski SR, Kelsey SF, et al. Diabetes and postoperative endophthalmitis in the EVS. Arch Ophthalmol 119: 650-656, 2001. Sternberg P, Martin DF. Management of endophthalmitis in the Post-Endophthalmitis Vitrectomy Study Era. Arch Ophthalmol 119: 754-755, 2001. Wisniewski SR, Capone A, Kelsey SF, et al. Characteristics after cataract extraction or secondary IOL among patients screened for the EVS. Ophthalmology 107: 1274-1282, 2000. Doft BM, Kelsey SF, Wisniewski SR. Retinal detachment in the Endophthalmitis Vitrectomy Study. Arch Ophthalmol 118: 1661-1665, 2000. Doft BH, Kelsey SF,Wisniewski SR, and the EVS Study Group. Additional procedures after the initial vitrectomy or tap-biopsy in the EVS. Ophthalmology 105: 707-716, 1998. Johnson MW, Doft BH, Kelsey SF, et. al. The Endophthalmitis Vitrectomy Study. Relationship between clinical presentation and microbiologic spectrum. Ophthalmology 104: 261-272, 1997. Bannerman TL, Rhoden DL, McAllister, et. al. The source of coagulase-negative staphylococci in the Endophthalmitis Vitrectomy Study: A comparison of eyelid and intraocular isolates using pulsed-field gel electrophoresis. Arch Ophthalmol 115: 357-361, 1997. Wisniewski SR, Hammer ME, Grizzard WS, et al. An investigation of the hospital charges related to the treatment of endophthalmitis in the EVS. Ophthalmology 104: 739-745, 1997. Barza M, Han DP, Doft BH and the EVS Study Group. Microbiological factors and visual outcome in the EVS. (Letter to Editor). Am J Ophthalmol 124: 127-130, 1997. Harry W. Flynn, Jr., MD presented by:

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Barza M, Paven PR, Doft BH et al. Evaluation of microbiology diagnostic techniques in postoperative endophthalmitis in the EVS. Arch Ophthalmol 115: 1142-1150, 1997. Han DP,Wisniewski SR,Wilson LA, Barza M,Vine AK, Doft BH, Kelsey SF, and the EVS Group. Spectrum and susceptibilities of microbiologic isolates in the EVS. Am J Ophthalmol 122: 1-17, 1996. Flynn HW Jr, Meredith TA. Interpreting the results of the EVS (Letter to Editor) Arch Ophthalmol 114: 10278, 1996. Peyman GA. EVS, a different point of view. (Editorial) Arch de la Sociedad Espanola de Oftalmologia 3: 205207, 1996. Davis JL (Editorial) Intravenous antibiotics for endophthalmitis. Am J Ophthalmol. 122: 724-726, 1996. Endophthalmitis Vitrectomy Study Group: Microbiologic factors and visual outcomes in the Endophthalmitis Vitrectomy Study. Am J Ophthalmol 122: 830-846, 1996. Endophthalmitis Vitrectomy Study Group. Results of the Endophthalmitis Vitrectomy Study. A randomized trial of immediate vitrectomy and of intravenous antibiotics for the treatment of postoperative bacterial endophthalmitis. Arch Ophthalmol 113: 1479-1496, 1995. Doft BH. The Endophthalmitis Vitrectomy Study. Arch Ophthalmol 109: 487-489, 1991. Endophthalmitis after Strabismus Surgery: Reccia FM, Baumal CR, Sivalingan A, et al. Endophthalmitis after pediatric strabismus surgery. Arch Ophthalmol 118: 939-944, 2000. Rosenbaum AL (editorial) Endophthalmitis after strabismus surgery. Arch Ophthalmol 118: 982-983, 2000. Kivlin JD, Wilson ME Jr., and the Periocular Infection Study Group. Periocular infection after strabismus surgery. J. Pediatric Ophthalmol Strabismus 32: 42-49, 1995. Thomas JW, Hamill MB, Lambert HM, Streptococcus pneumoniae endophthalmitis following strabismus surgery. Arch Ophthalmol 111: 1170-1171, 1993. Compatibility of Intraocular Antibiotics: Jindal A, Pathengay A, Khera M, Jalali S, Mathai Annie, Pappuru RR, Narayanan R, Sharma S, Das T and Flynn HW Jr., Combined Ceftazidime and Amikacin Resistance Among Gram-Negative Isolates in Acute-Onset Posoperative Endophthalmitis: Prevalence, Antimicrobial Susceptibilities, and Visual Acuity Outcome. Journal of Ophthalmic Inflammation and Infection 2013, 3:62. http://www.joii-journal.com/content/3/1/62.

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Eifrig CWG, Scott IU, Flynn HW, Jr, Smiddy WE, Newton J. Endophthalmitis after pars plana vitrectomy: incidence, causative organisms, and visual acuity outcomes. Am J Ophthalmol 138: 799-802, 2004. Cohen SM, Flynn HW Jr, Murray TG, Smiddy WE and the Postvitrectomy Endophthalmitis Study Group. Endophthalmitis after pars plana vitrectomy. Ophthalmology 102: 705-712, 1995. Kaiser RS, Prenner J, Scott IU, Brucker AJ, Flynn HW Jr., et al. The Microsurgical Safety Task Force: Evolving guidelines for minimizing the risk of endophthalmitis associated with microincisional vitrectomy surgery. Retina 2010 April; 30(4): 692-699. Foster RE, Rubsamen PE, Joondeph BC, Flynn HW Jr., Smiddy WE. Concurrent Endophthalmitis and Retinal Detachment. Ophthalmology 1994; 101: 4

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