Timely vitrectomy without intraocular lens removal for acute endophthalmitis after cataract surgery

Abstract

AIM: To investigate the clinical features, causative organisms and effects of timely vitrectomy and silicone oil tamponade without intraocular lens (IOL) removal in the treatment of acute-onset endophthalmitis after cataract surgery (APCE). METHODS: We retrospectively analyzed the clinical features and microbiological factors in 10 eyes of 10 patients with APCE at Tianjin Medical University General Hospital from January 2010 to December 2018. Data on the clinical features, causative organisms, visual acuity, intraocular pressure (IOP) and complications were collected. The mean follow-up period was 25.5mo. RESULTS: The mean age of the patients was 71.4y. The mean time between cataract surgery and the onset of endophthalmitis was 2.0d. Preoperative visual acuity ranged from no light perception to hand motion. After vitrectomy, the visual acuity increased in nine eyes (90%), and was unchanged in one eye (10%). A significant difference was observed between the mean preoperative (36.3±7.1 mm Hg) and postoperative IOP (14.9±4.3 mm Hg, P<0.05). Staphylococcus epidermidis was isolated in 5 eyes, S. aureus in 2 eyes, and Enterococcus in 1 eye. Postoperative complications mainly included fibrin exudates in the anterior chamber at the early stages in all eyes and temporary IOP elevation in one eye. No retinal detachment or ocular atrophy was observed during the follow-up period. CONCLUSION: Under systemic antibiotic treatment and timely diagnosis, vitrectomy and silicone oil tamponade without IOL removal is a safe and effective method for APCE.

Intraocular lens removal or not during vitrectomy for acute infectious endophthalmitis after cataract surgery

“…Removal or not of the intraocular lens (IOL) during vitrectomy in such case is controversial, without an expert consensus. In this issue, we publish an article entitled "Timely vitrectomy without intraocular lens removal for acute endophthalmitis after cataract surgery" written by Guo et al [1] . In the paper, they presented 10 eyes of 10 patients with acute endophthalmitis that occurred one to three days after cataract surgery.…”

“…The visual acuity improved remarkably in 9 eyes, while one eye remained with no light perception. They concluded that their management was safe and effective [1] . While the article was reviewed, one of our reviewers did not agree with the authors' method that without IOL removal.…”

“…We thereafter decided to publish the paper as a brief report in order to call upon more comment and discussion on this technique. From Guo et al's [1] report, we could summarize their successful management for control of the infection without recurrence in all 10 cases mainly due to the following elements. First, they did the earliest intervention for the acute infection.…”

“…Third, recent advanced micro-incision vitrectomy instruments and panoramic microscopy facilitate the manipulation to be more accurate and efficient. However, they neither mention intraocular antibiotics use and the posterior capsule cut, nor explain the necessity of silicone oil injection [1] . In regards to systemic and intracameral antibiotics use, as Althiabi et al [2] pointed out, the role of systemic antibiotics and vitrectomy is unclear and practice patterns vary widely.…”

“…A severe inflammation with corneal edema, hypopyon and fibrin exudates in the anterior chamber, and dense vitreous opacity or suppuration, can be treated with vitrectomy and antibiotic lavage [3] . The cases in Guo et al's [1] series could be classified as the severe inflammation in terms of severity. Moreover, the characteristics, treatment and prognosis of the endophthalmitis vary due to different pathogens with various virulence and its reaction to antibiotics.…”