Author Affiliations: Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, Florida (Drs Miller and Alfonso); and the Department of Ophthalmology, Queen's University, Hotel Dieu Hospital, Kingston, Ontario, Canada (Dr Almeida).
We thank Singhla and colleagues for their interest in our article.1 We agree that there are different modes of microbial entrance into the eye for the different types of endophthalmitis (postsurgical, endogenous, and traumatic). Our review of all consecutive cases of endophthalmitis from January 1, 1999, through December 2008 reviewed all types. However, most of the 229 matched pairs were from postcataract or postsurgical cases. These are the types of cases in which antibiotic prophylaxis would be used to sterilize or reduce ocular surface contamination and provide protective, therapeutic levels in the anterior chamber for the prevention of endophthalmitis. Our data agree with results from the Endophthalmitis Vitrectomy Study,2 in which there was a significant difference in culture positive rates for the anterior chamber (48.9%; 158 of 323) vs the vitreous (87.3%; 282 of 323) samples. The more recent multicenter European Society of Cataract and Refractive Surgery Endophthalmitis Study3 also confirmed the nonconcordance of anterior chamber and vitreous cultures (76.2%, with sensitivity and specificity of 60% and 91%, respectively. For this type of population, we think that are conclusions are applicable and generalizable.
Miller D, Almeida D, Alfonso EC. Anterior Chamber and Vitreous Concordance in Endophthalmitis—Reply. Arch Ophthalmol. 2011;129(9):1243-1244. doi:10.1001/archophthalmol.2011.236