Modern Endophthalmitis Control: The Complete Early Vitrectomy for Endophthalmitis (CEVE) Protocol and Surgical Prophylaxis.

This article presents an overview of endophthalmitis, a severe intraocular inflammatory condition that can develop following surgery, intravitreal injections (IVIs), or ocular trauma. Endogenous cases may also arise, particularly in patients with compromised immune systems. A broad spectrum of pathogens, including bacteria, fungi, and viruses, can be involved, with some displaying high virulence. Given the rapid progression and potential for vision-threatening complications or systemic involvement such as sepsis, immediate and appropriate intervention is essential. Surgical management, especially vitrectomy, plays a central role in treatment. The Complete Early Vitrectomy for Endophthalmitis (CEVE) protocol has demonstrated high effectiveness, particularly when integrated into outpatient ophthalmic surgical practices. This review describes the protocol's practical application in such settings. In addition, it discusses preventive strategies for ocular surgery and injections, with a particular focus on the judicious use of antimicrobial agents. Incorrect antibiotic use, including unnecessary prescribing, inadequate dosing, or prolonged treatment, remains a leading contributor to the development of antimicrobial resistance and warrants critical evaluation. In summary, the CEVE approach appears to offer broad efficacy across different causes of endophthalmitis. Povidone-iodine (PI) remains the most effective agent for perioperative antisepsis. The use of prophylactic antibiotics should be confined to brief, high-potency topical therapy following intraocular procedures, including cataract surgery and phacovitrectomy. Current evidence does not support the routine use of prophylactic antibiotics after intravitreal injections due to minimal benefit and the risk of promoting resistant organisms.