دانلود کتاب اندوفتالمیت در تجارب بالینی

Over the past few decades, we have a better understanding of the pathophysiology of intraocular infections through clinical and microbiological studies, and we can initiate more prompt diagnosis and treatment to improve outcomes in the manage­ment of endophthalmitis. It is amazing to witness the changes in the differential diagnoses and management of endophthal­mitis in recent years. With the increases in invasive ophthal­mic procedures, there is a need for a concise, up-to-date reference on clinical endophthalmitis which includes options for antimicrobial therapy and the role of pars plana vitrec­tomy. This book, entitled Endophthalmitis in Clinical Practice, meets the need very well.

Multiple chapters in the book are dedicated to specific subtopics in endophthalmitis management. The background section includes historical information as well as details on the Endophthalmitis Vitrectomy Study (EVS), as well as con­troversies in the use of intracameral antibiotics during cata­ract surgery.

This follows a discussion on the various etiologies of endo­phthalmitis and includes initial treatment strategies in each subgroup. As part of diagnostic evaluation, sections include imaging for documentation of clinical features, echographic characteristics, and complications affecting visual outcomes. Management of more difficult cases may require retreatment after initial antimicrobials and uncommonly may require removal of the capsular bag and the intraocular lens (IOL) in specific cases. Illustrations of pre- and posttreatment cases are shown from the authors’ clinical practice. Pars plana vitrectomy is often considered in more rapidly advancing cases, especially in endophthalmitis after cataract surgery in patients presenting with light perception visual acuity. The use of vitrectomy may be limited by corneal or media opacities, but small-gauge vitrectomy approaches may allow a simpler approach to core vitrectomy without the need for conjunctival dissection or suture placement.

Antimicrobial therapy is then discussed. This includes ini­tial broad coverage of both Gram-positive and Gram-negative bacteria. Likewise, antifungal agents including amphotericin B and voriconazole can be utilized in suspected or confirmed endophthalmitis caused by fungi. Alternative agents for resistant organisms are reviewed and the tailoring of treatment for subsequent management.

The use of intravitreal injections for retinal diseases has become the leading ophthalmic procedure in the United States. In these patients, endophthalmitis can occur from solution contamination as well as from the injection proce­dure itself. These cases generally present early after injection and frequently involve oropharyngeal flora from contamina­tion of the needle or the ocular surface during drug delivery. Streptococcus as well as other Gram-positive organisms in these cases may have a more advanced clinical presentation with poor visual and anatomic outcomes.

This text will undoubtedly prove to be a valuable asset for clinical ophthalmologists as well as retinal specialists. The abundant clinical illustrations, concise tables, and reference material enhance its readability. With the exception of the EVS, there are no major randomized clinical trials on which to base definitive recommendations. Rather, the authors uti­lize published case series and their own experience to provide guidelines regarding the prompt and efficient management of endophthalmitis.