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©The Author(s) 2026. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 26, 2026; 14(6): 118263
Published online Feb 26, 2026. doi: 10.12998/wjcc.v14.i6.118263
Published online Feb 26, 2026. doi: 10.12998/wjcc.v14.i6.118263
Areas of uncertainty in endophthalmitis care
Ramesh Venkatesh, Prathibha Hande, Nagesha Krishnappa Chokkahalli, Prashanth Ranganath, Vishma Prabhu, Karishma Tendulkar, Pragati Raj, Gaurav Malwe, Shubhangi Tripathi, Preksha Biradar, Alisha Sirsikar, Department of Ophthalmology, Narayana Nethralaya, Bangalore 560010, India
Edwin James, Department of Ophthalmology, Government Medical College Kollam, Kollam 691574, Kerala, India
Rupal Kathare, Chaitra Jayadev, Department of Retina, Narayana Nethralaya, Bangalore 560010, India
Naresh Kumar Yadav, Department of Vitreo Retina, Narayana Nethralaya, Bangalore 560010, India
Co-first authors: Ramesh Venkatesh and Prathibha Hande.
Author contributions: Venkatesh R and Hande P contributed equally to this manuscript and are co-first authors. Venkatesh R conceptualized the review, defined the overall scope, and provided senior oversight of content and structure; James E, Hande P, Prabhu V, Jayadev C, and Yadav NK contributed to literature review, thematic organization, and critical interpretation of evidence; Chokkahalli NK, Ranganath P, Kathare R, Tendulkar K, Raj P, Malwe G, Tripathi S, Biradar P, and Sirsikar A assisted in data extraction, synthesis of key concepts, and drafting of specific sections. All authors contributed meaningfully to the conception, design, and development of this review. All authors participated in manuscript drafting and critical revision for important intellectual content, approved the final version, and agreed to be accountable for all aspects of the work.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ramesh Venkatesh, Consultant, Department of Ophthalmology, Nara
Received: December 28, 2025
Revised: January 12, 2026
Accepted: February 6, 2026
Published online: February 26, 2026
Processing time: 47 Days and 14.7 Hours
Revised: January 12, 2026
Accepted: February 6, 2026
Published online: February 26, 2026
Processing time: 47 Days and 14.7 Hours
Core Tip
Core Tip: Endophthalmitis remains a vision-threatening ophthalmic emergency in which clinicians must make urgent decisions despite substantial diagnostic and therapeutic uncertainty. Overlapping clinical presentations, frequent culture negativity, evolving antimicrobial resistance, and variable response to treatment complicate early management. Key controversies persist regarding the timing and extent of vitrectomy, selection and dosing of intravitreal antimicrobials, and the role of adjunctive corticosteroids. This review highlights these real-world gray zones and emphasizes the need for individualized, adaptive decision-making rather than rigid, algorithm-based approaches.