Treatment effect of chronic pseudophakic bacterial endophthalmitis

Abstract

Objective To evaluate the Ceatment effect of chronic bacterial endophthalmitis after intraocular lens (IOL) implantation and make some treatment advice. Methods Medical records of 4 cases of microorganism positive pseudophakic endophthalmitis in our unit were reviewed between 2004 and 2009. Initial therapy included pars plana vitrectomy (PPV) and posterior capsulorhexis combined with intraocular vancomycin. Subconjunctival antibiotics and steroid was applied after the operation. The removed capsule was divided for smear staining and aerobically and anaerobically culture together with the removed vitreous. Oral azithromycin and roxithomycin was a treatment option for recurred patients. Results Four eyes of 4 patients were reviewed that 3 females and 1 male. The average age was 75 years old (67 to 81 years). The mean time period between cataract surgery and symptoms of endophthalmitis was 8 weeks (5 to 11 weeks). Visual acuity before surgery was hand movement in one eye, counting fingers in 2 eyes and 0.06 in one eye. Propionibacterium acnes were found in 3eyes and coagulative-negative staphylococcus in 1 eye. Vitreous base abscess, retinal vasculitis and haemorrhage intermediate uveitis, vitreous veil could be found during operation. Two recurred eyes were successfully cured by repeated subconjunctival dexamethasone and tobramycin, oral azithromycin and roxithomycin. No recurrence was noticed at last follow-up over 16 months. The best corrected visual acuity was 0.8, 0.5, 0.2 and 0.3 at last follow-up, respectively. Conclusious After PPV and posterior capsulothexis, the antibiotics application should be prolonged to avoid recurrence in chronic pseudophakic bacterial endophthalmitis. The role of macrolides antibiotics in treating the chronic pseudophakic bacterial endophthalmitis deserves respect. Key words: Chronic endophthalmitis; PPV; IOL; Macrolides; Antibiotics