Sir,

We thank Drs Benjamin Pijl and Niels Crama1 for their instructive comments regarding our article.2 Benjamin Pijl and Niels Crama highlighted the following introductory statement: ‘The information of presenting and final visual acuity (VA) specified to the causative organisms and the choice of the intravitreal antibiotics.’

The aim of our paper was to show the spectrum of bacterial isolates that caused endophthalmitis after cataract surgery at our tertiary referral centre in Northern Taiwan, and whether there were differences from findings in other regions. We found that Pseudomonas aeruginosa was the most commonly isolated organism (n=13, 38.2%), and that 12 of 13 patients (92.3%) achieved the final VA worse than 5/200. We agree that details on presenting and final VA of Staphylococcus aureus and other negative bacterial cultures might have provided more information in our study. As we focused our findings on P. aeruginosa and their VA outcome, we provided the data concisely.

Using ceftazidime instead of amikacin led to a higher rate of antibiotic susceptibility in our study. Thus, concerns have emerged that ceftazidime may positively influence future treatment outcome in acute postoperative bacterial endophthalmitis after cataract surgery among the population in Northern Taiwan. We treated our patients with a regimen of intravitreal vancomycin and amikacin rather than vancomycin and ceftazidime. We thus concluded that the use of regimen (vancomycin and amikacin) still provides good coverage in our region.

On the basis of the results of antibiotic susceptibility in our study, one might argue that ceftazidime is better than amikacin in Northern Taiwan. A change in antibiotic sensitivity has been reported over the past two decades.3 It definitely needed to be periodically surveyed. However, there was in fact not enough clinical evidence in our study for the claim by Drs Benjamin Pijl and Niels Crama.

Obviously, further investigation should continue to provide information about post-cataract endophthalmitis. We appreciate Drs Benjamin Pijl and Niels Crama’s interest and thank them for giving us an opportunity to consider an important point that we had not fully expressed.