We thank Dr Shoaib for his interest in our article. We agree with Dr Shoaib that delayed-onset and acute-onset cases of endophthalmitis represent two extremes of one wide spectrum. The purpose of our study was to compare retrospectively these two extremes in terms of clinical presentations, organisms cultured, visual acuity outcomes, and recurrences. Our study included all culture-proven cases of endophthalmitis that were treated at the Bascom Palmer Eye Institute, which differs from the prospective nature of the European Society of Cataract and Refractive Surgeons Endophthalmitis Study.
Because most of the patients in our study were from outside medical offices and had been referred to us for treatment, there was no access to information regarding the perioperative prophylaxis regimens in most cases. As was shown in the Endophthalmitis Vitrectomy Study, systemic antibiotics were thought to provide no additional benefit in treating endophthalmitis after cataract surgery, and therefore were not used in our series.
We agree with Dr Shoaib that the rates of endophthalmitis seem to be decreasing, but the reasons for this decrease are uncertain. We cannot attribute this decrease to improved topical antibiotic use, nor to widespread use of intracameral antibiotics. Most surgeons in our area do not use intracameral antibiotics, but do adhere to stringent protocols for aseptic technique, including the use of topical povidone iodine prophylaxis in all patients.