I appreciate Dr Grzybowski’s letter regarding a recent editorial about postoperative endophthalmitis prophylaxis. I cannot agree more with every comment that is made. Yes, the peer-reviewed publications are conflicting and, yes, the lack of definitive answers keeps the Intracameralists and the Topicalists from coming to consensus. In a perfect world we could design a classical randomized clinical trial that would, probably, largely resolve the controversy. The sad truth is that the size and cost of the perfect gold-standard trial is such that we are likely left with imperfect studies suggesting imperfect conclusions. So the main point of the editorial is that circumstantial evidence is probably the best we are going to get, so the controversy is not going to die anytime soon.

I wish it were not so, but it is what it is.