Distinguishing infectious endophthalmitis from noninfectious inflammation – Cataract surgery and intravitreal injection

Abstract

AbstractWith both cataract surgery and intravitreal injections, there is a risk of infectious or non‐infectious intraocular inflammation. The ability to differentiate between the two types of inflammatory reaction is important as the delay in treatment in the former case or unnecessary treatment in the latter case can have consequences.Infectious endophthalmitis is usually associated with pain, hypopyon, severe anterior chamber reaction, hyperemia and significant vision loss, while symptoms associated with sterile endophthalmitis are often less severe. Nevertheless, although rarely, non‐infectious intraocular inflammation can be potentially vision‐threatening after phacoemulsification cataract surgery or intravitreal injection. Since it may be easily mistaken for infectious endophthalmitis, a clear understanding of this pathology is essential. If the ophthalmologist is not sure about the sterile origin of the inflammation, this complication must be treated as an acute endophthalmitis because of the severe visual outcome of this intraocular infection without antibiotic therapy. The aetiology of sterile endophthalmitis remains uncertain and a multifactorial origin must be considered. We will provide further insight into the mechanisms, causative factors and clinical differences among various types of inflammation, with the goal that clinicians can reduce the risk of these events in the future.