Clinical observation of acute infective endophthalmitis after cataract extraction combined with intraocular lens implantation

Abstract

Objective To observe and discuss the treatment strategy of acute infective endophthalmitis after cataract extraction combined with intraocular lens (IOL) implantation. Methods The clinical data of 9 patients with acute infectious endophthalmitis after cataract extraction and IOL implantation were collected from 2011~2017 years′ ophthalmology hospital in Guangzhou. Among them, there was one case of endophthalmitis after cataract surgery in Guangzhou Eye Hospital, 8 cases of endophthalmitis referral patients after cataract surgery in primary hospitals.Check the results of the patient′s visual acuity, intraocular pressure, anterior segment, ocular ultrasound scan and so on. The patients were treated with parsplana vitrectomy (PPV) and the patients were infected with IOL and silicone oil filling. During the operation, the anterior chamber fluid and the glass fluid were given to the bacteria and fungi. Results Among the 9 patients, there were 1 patients with diabetes, 2 patients with hypertension, and the rest had no long-term systemic disease. All patients in this acute infectious endophthalmitis after cataract surgery in time was 1~9 days, showed a sharp decline in visual acuity, eye pain, conjunctival hyperemia and edema, corneal edema of different degrees, aqueous humor with/without hypopyon and anterior chamber exudation membrane etc.. The results of ocular ultrasound examination revealed the vitreous opacity of the patient and the fundus of the eyes were not seen. In 9 cases, 8 cases were treated by full vitrectomy and one case of full vitrectomy was not performed due to corneal opacity. 6 cases were practiced intravitreal injection before vitrectomy. In the first 3 cases were taken out with IOL and silicone tamponade, but the other 6 cases were not necessary of IOL removal and silicone tamponade. Postoperative visual acuity was improved in 7 of 9 cases. Visual acuity 0.01~0.09 were in 2 cases, 0.1~0.3 were in 3 cases and 0.3~0.5 were in 2 cases. one case with no improvement of vision and 1 case was practiced evisceration due to infection spreading. Conclusion PPV is an effective treatment for acute infectious endophthalmitis after cataract surgery. It plays an important role on controlled the infection and retained the visual function of patients, especially in well corneal condition cases. Key words: Acute infective endophthalmitis; Cataract removal; Parsplana vitrectomy