Certain limitations of the EVS should be recognized. First, the EVS recommendations regarding the use of vitrectomy in acute-onset endophthalmitis following cataract surgery or secondary intraocular lens implantation may not be directly applied to other forms of endophthalmitis. For example, although coagulase-negative Staphylococcus accounted for 70% of culture-positive cases in the EVS, bleb-associated, traumatic, and endogenous types of endophthalmitis are more likely to be caused by organisms of greater virulence. In such cases, the benefits of vitrectomy may be greater because of the mechanical removal of bacteria and toxins from the eye. Second, amikacin and ceftazidime were the only systemic antibiotics evaluated in the EVS. Although patients in the EVS derived no demonstrable benefit from these systemic antibiotics, the study made no recommendations regarding treatment with additional antimicrobial agents (eg, systemic fluoroquinolones) or systemic antimicrobial agents for other types of endophthalmitis (eg, chronic, bleb-associated, traumatic, fungal, and endogenous forms). Third, potential study subjects with significant opacification of the anterior chamber or without light perception were excluded from the EVS. Because these eyes with more severe infection or involving more virulent organisms were excluded from the EVS, the effect might have shifted the EVS outcomes to more favorable results. Although the EVS provides general guidelines, the clinician ultimately must decide on the best treatment strategy for the individual patient.