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Am I taking the right treatment for post-cataract surgery endophthalmitis?

Q: I am a 67 years old man and would like to have a second opinion regarding my left eye for post-cataract surgery endophthalmitis. I have undergone vitrectomy, intra-ocular lens (IOL) explantation, intra-ocular antibiotics (IOAB) and silicone oil. On examination the best-corrected visual acuity is 6/6, N6 in the right eye and CF at 1/2 mt in the left eye. My intra-ocular pressure was 19 mmHg in the right eye and 21 mmHg in the left eye. Anterior segment evaluation showed pseudophakia in the right eye and hypopyon and aphakia in the left eye. Fundus examination with binocular indirect ophthalmoscope showed disc within normal limits with attached retina with exudates with silicon oil bubble in the left eye. The doctor advised to continue the same treatment. On follow up my intra-ocular pressure was found 20 mmHg in the right eye and 16 mmHg in the left eye 8 months back. The doctor then advised to take intravitreal Voriconazole 100 mg / 0.1 ml, ceftazidine 2.25mg/0.1ml under topical anaesthesia in the left eye and prescribed Voriconazole 400 mg tab twice a day for 1 day followed by 200 mg twice a day for 2 weeks with monitoring, Predace eye drops in tapering dose in left eye, Vigamox eye drops and Voriconazole eye drop 6 times a day in the left eye. Injection was given in the left eye 7 months back and followed up again after two days. The anterior segment evaluation showed circumciliary congestion and membrane at pupillary area and hypopyon in the left eye. Fundus examination with binocular indirect ophthalmoscope showed disc within normal limits with attached retina, silicon oil with vitreous cuff in the left eye. The doctor has advised to repeat intravitreal Voriconazole and ceftazidine injection under topical anaesthesia in the left eye, which was given on the same day. He was advised to continue same topical and systemic treatment but after 3 more days the doctor suggested to start Wysolone an tapering dose of 60 mg/ 50/ 40/ 30/ 20/ 10/ 5 mg daily for 1 week, while monitoring blood pressure. Please advise.

A:The treatment seems satisfactory. The vision in the left eye, however, will not improve unless you have some IOL. The fact that silicon oil is in the left eye suggests retinal detachment and its treatment in the past. This will further compromise visual improvement. As long as your eye is comfortable, I would not give further treatment but if and when there is raised intraocular pressure, this will need to be monitored from time to time and treatment given.

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