Author reply

In response to the letter by Chen et al, we disagree with many of their assumptions and statements. We respond point-by-point to their concerns. In our published study, endophthalmitis was defined by the presence of positive intraocular cultures in addition to a clinical presentation consistent with endophthalmitis. All 49 patients included in our study presented with evidence of severe intraocular inflammation that supported a diagnosis of infectious endophthalmitis. Chen et al state that “progressive vitritis is a hallmark of any form of endophthalmitis,” but they failed to include any references in support of this statement. Our study was a retrospective case series and, as such, the presence or absence of vitritis was not always clearly recorded in the medical record, accounting for the relatively low percentage of patients with documented vitritis (25/49 [51%]). In fact, there were 6 patients with positive vitreous cultures who did not have vitritis clearly documented in the clinical notes. Thus, there were ≥31 of the 49 (63%) patients in our study with clear evidence of posterior segment involvement, with the true number likely even higher. Nevertheless, we disagree with the assertion that the presence of “progressive vitritis” is required to make a clinical diagnosis of endophthalmitis.