Historical aspects of the treatment of acute bacterial postoperative endophthalmitis. Literature review.

Treatment of acute bacterial postoperative endophthalmitis (AE) is an actual problem. The frequency of AE is directly influenced by worldwide increase of surgical activity with prevailing outpatient surgery. Somatic status of the patient, structure of his own and hospital microflora, rules of preoperative preparation and postoperative treatment play an important role. Features of AE treatment are extremely delicate and require a complex approach for obtaining a high functional result. The review covers key historical aspects resulting in a significant progress in AE treatment. Positive anatomical result is associated with the period of first attempts of antibiotics (AB) intravitreal injections (IVI) beginning from 1940s. Development of automated systems for manipulations with pathologic vitreous in combination with AB intravitreal injections (IVI) resulted the first positive functional results in 1970s. Further investigations devoted to study of AB pharmacokinetics and pharmacodynamics, development of more advanced vitrectomy systems, complex analysis of pathogenic microflora antibiotic sensitivity, use of optimal criteria and terms of surgical intervention gave a possibility to improve functional and anatomical results of management of this severe postoperative complication. Modern clinical investigations are aimed to achieve the maximal functional results. For this purpose it is necessary to follow several fundamental principles: 1) removal of pathological substratum from the vitreous cavity (3‑port vitrectomy) must be done after diagnosis as soon as possible (during one hour); 2) vitrous cavity and anterior chamber content must be qualitatively taken for microflora cultering and antibiotic sensitivity test; 3) intravitreal antibiotics must cover the entire spectrum of possible pathogenic microorganisms before obtaining of bacterial seeding result; 4) it is necessary to continue one the most effective antibiotic with according to data of microbiologic analysis.

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