Intraocular Lens Explantation Research Articles

Anterior segment optical coherence tomography in black‐on‐clear polypseudophakia

Anterior segment optical coherence tomography in black‐on‐clear polypseudophakia

Scleral Fixation of a One-Piece Toric Intraocular Lens

To describe a novel technique for toric intraocular lens (IOL) repositioning and fixation in the absence of adequate capsular support. Case report and literature review. Two cases are presented with scleral fixation of a one-piece toric IOL (SN6AT series; Alcon Laboratories, Inc., Fort Worth, TX). In both cases, toric IOLs initially placed within the capsular bag became decentered due to poor capsular support. To avoid the potential complications of lens explantation and maintain the astigmatic benefits of the toric IOL, scleral fixation of the lenses was performed. The Hoffman technique was used to create reverse scleral pockets without conjunctival dissection. A 10-0 non-dissolvable suture was used to capture and then secure the lens haptics in a lasso-type fashion. Sutures were then buried within the previously created scleral pockets. Both patients had well-centered lenses postoperatively that remained stable at last follow-up, 30 months postoperatively. In the absence of adequate capsular support, scleral fixation is a viable option for one-piece toric IOL fixation to avoid IOL explantation.

Glued intraocular lens

To review the changes and results of glued intraocular lens (IOL) procedure in eyes with inadequate capsule. The recent review of 735 eyes with glued IOL showed 486 rigid glued IOL, 191 foldable IOL, 10 glued iris prosthesis, 16 eyes with glued IOL with pupilloplasty and 32 eyes with glued IOL with penetrating keratoplasty. The postoperative best corrected visual acuity (BCVA) in eyes with the rigid glued IOL was 0.38 ± 0.27. There was a significant improvement in BCVA (P = 0.000). The mean postoperative BCVA in foldable glued IOL was 0.39 ± 0.29. IOL optic-related complications included optic capture and decentration. Haptic-related complications seen are haptic extrusion, haptic dislodgement, broken haptic and subconjunctival haptic. Most of the haptic-related problems are due to improper scleral tucking. The second surgeries in rigid glued IOL included IOL repositioning (2.2%), haptic repositioning (1%), conjunctival peritomy closure (0.8%), posterior segment surgery (1.2%) and IOL explantation (0.4%). The surgical modifications included glued IOL scaffold and vertical glued IOL. Glued IOL, which was combined with corneal procedures such as penetrating keratoplasty, Descemet stripping automated endothelial keratoplasty and Descemet's membrane endothelial keratoplasty, showed good visual and anatomical outcome. Glued IOL and its surgical modifications showed good visual outcome with minimal complications in the recent review of its results and complications profile. However, long-term functional and anatomical outcome has to be observed in future.

Refractive Changes after Removal of Anterior IOLs in Temporary Piggyback IOL Implantation for Congenital Cataracts

PurposeTo assess the refractive change and prediction error after temporary intraocular lens (IOL) removal in temporary polypseudophakic eyes using IOL power calculation formulas and Gills' formula.MethodsFour consecutive patients (7 eyes) who underwent temporary IOL explantation were enrolled. Postoperative refractions calculated using IOL power calculation formulas (SRK-II, SRK-T, Hoffer-Q, Holladay, and the modified Gills' formula for residual myopia and residual hyperopia) were compared to the manifest spherical equivalents checked at 1 month postoperatively.ResultsThe mean ages of temporary piggyback IOL implantation and IOL removal were 6.71 ± 3.68 months (range, 3 to 12 months) and 51.14 ± 18.38 months (range, 29 to 74 months), respectively. The average refractive error was -13.11 ± 3.10 diopters (D) just before IOL removal, and improved to -1.99 ± 1.04 D after surgery. SRK-T showed the best prediction error of 1.17 ± 1.00 D. The modified Gills' formula for myopia yielded a relatively good result of 1.47 ± 1.27 D, with only the variable being axial length.ConclusionsFormulas to predict refractive change after temporary IOL removal in pediatric polypseudophakia were not as accurate as those used for single IOL implantation in adult eyes. Nonetheless, this study will be helpful in predicting postoperative refraction after temporary IOL removal.

Ursache von Austausch und Explantation von Intraokularlinsen

This study was performed to analyse the reasons for explantation/exchange of intraocular lenses (IOL), which had originally been implanted for the correction of aphakia during cataract extraction. All cases with IOL explantation, which had been performed at one institution between 1/2008 and 12/2009 were analysed retrospectively. A total of 105 eyes of 100 patients were analysed. The median time interval between implantation and explantation of the IOL was 5.9 years (min. 0, max. 29.6). The most frequent cause for the intervention was subluxation/dislocation of the implant in 55.2% of cases. This group comprised 21% of cases with subluxation within the capsular bag in pseudoexfoliation syndrome. Other reasons were optical problems/incorrect IOL power (21%), calcification of hydrophilic acrylic IOL (7.6%), corneal decompensation associated with an anterior chamber lens (4.8%), and single cases with varying problems. The reasons for IOL exchange presented in this study are comparable to those of other series in the literature. Explantations due to optical problems may gain weight in the future due to a rise in refractive procedures and demands.

Retropupillary iris claw intraocular lens for aphakia

To assess outcomes of the iris claw intraocular lens implanted in the retropupillary position for correction of aphakia without adequate capsular support. Retrospective study of patients consulted at two private practices and a tertiary public hospital clinic in Brisbane, Queensland. Thirty-two consecutive patients who underwent posterior chamber insertion of the iris claw intraocular lens alone or in combination with other procedure/s by the same consultant ophthalmologist (GL). Lens power was calculated using an A-constant of 117.0. Clinical examination. Thirty-four eyes in 32 patients (23 male, 9 female) were included in the study. Indications for surgery were pseudophakic bullous keratopathy (n = 14), aphakia from previous lens extraction/lensectomy (n = 9), subluxation of intraocular lens (n = 7), cataract extraction (n = 2), explantation of anterior chamber intraocular lens due to uveitis (n = 1) and for Baerveldt tube insertion (n = 1). Follow-up duration ranged from 1 to 68 months. Of the 26 eyes followed for at least 6 months, the final vision improved in 69% (n = 18), remained unchanged in 8% (n = 2) and worsened in 23% (n = 6). Final visual acuity was 6/12 or better in 58% (n = 15). Complications included iris trauma/defect (n = 8), pupil irregularity/ovalization (n = 6), microhyphaema (n = 2) and lens decentration (n = 2). Implantation of the iris claw intraocular lens in the retropupillary position is a useful technique for correction of aphakic eyes with sufficient iris support, avoiding the corneal complications of an anterior chamber intraocular lens and the surgical challenge of a sutured posterior chamber intraocular lens.

Intraocular Lens Explantation Technique for One-piece Acrylic Lenses

To present a simple technique to remove a one-piece, acrylic AcrySof (Alcon Laboratories Inc) intraocular lens (IOL) via the original incision. The AcrySof IOL is removed via the original (2.75-mm) incision, without cutting or folding the IOL or widening the incision. After the IOL is viscodissected from the capsular bag and brought into the anterior chamber, toothed forceps hold the optic through the incision while the manipulator enters the side-port incision and hooks onto the optic 180° away. With the forceps pulling and the lens manipulator pushing the IOL toward the incision, the IOL will fold and be delivered. A one-piece, acrylic (Acrysof) IOL can be removed without cutting or folding the lens and without widening the original 2.75-mm incision.

Causes of IOL explantation in Spain

To study the reasons and the demography of pseudophakic intraocular lens (IOL) explantation in Spain. In this observational multicenter retrospective study, the cases studied correspond to the 15 centers that constitute the Nodo Calidad Visual y Cirugia Refractiva of the Red Tematica de Investigacion Cooperativa (RETICS) sponsored by the Spanish Ministry of Health. Clinical data from all the patients who underwent explantation were assessed. The different reasons that caused the decision of explantation were analyzed. A total of 257 explanted pseudophakic IOLs have been studied. Patients' mean age when explantation occurred was 67.5 years (SD 13.5 [22-99]) and 135 were female (52.5%). The main causes for explantation were dislocation/decentration in 145 cases (56.3%), incorrect lens power in 33 cases (12.8%), IOL opacification in 29 eyes (11.3%), neuroadaptation failure in 16 cases (6.2%), pseudophakic bullous keratopathy in 6 eyes (2.3%), endophthalmitis in 5 cases (1.9%), and "other causes" in 23 eyes (8.9%). Treatment after explantation was posterior chamber IOL implantation in 149 eyes (58%), anterior chamber IOL implantation in 49 eyes (19.1%), aphakia in 39 eyes (15.2%), and missing information in 20 cases (7.8%). Mean time from implantation to explantation was 3.97 (SD 4.68 [0.005-21.1]) years. Dislocation/decentration (most of the time with lens in the bag) is the main cause for explantation in Spain, followed by incorrect lens power (which decreased greatly over past years) and IOL opacification. Posterior chamber IOL implantation is the most elected treatment after explantation.

Surgical and Visual Outcomes of the Type I Boston Keratoprosthesis for the Management of Aniridic Fibrosis Syndrome in Congenital Aniridia

To report the clinical features and surgical management of aniridic fibrosis syndrome using the type I Boston Keratoprosthesis (KPro). Interventional case series. Retrospective chart review of 9 eyes in 9 patients with congenital aniridia that developed aniridic fibrosis syndrome. All patients had clinical diagnosis of congenital aniridia. Previously, all patients had undergone cataract surgery with posterior chamber intraocular lens (IOL) implantation and 7 patients had existing tube shunts. In all cases, fibrosis presented as progressive retrocorneal and retrolenticular membrane formation causing displacement of the IOL and secondary corneal decompensation. Two eyes had tractional folds in the retina with posterior extension of the membrane. The management included IOL explantation in 7 of 9 cases, removal of fibrosis with pars plana vitrectomy in all 9 patients, and implantation of a type I Boston KPro in all eyes. At a mean final follow-up of 26.1 months (range 6 to 48 months), vision remained improved in all patients. No patient had recurrence of the fibrotic membrane after KPro implantation. This study represents another case series describing aniridic fibrosis syndrome and the largest study to report utilization of the type I Boston KPro in such patients. As the fibrosis can cause IOL dislocation, corneal decompensation, hypotony, and retinal detachment, monitoring for aniridic fibrosis syndrome in congenital aniridia with early surgical intervention is recommended. Type I Boston KPro may be considered in the surgical treatment of this condition.

A Case of Postoperative Endophthalmitis by Extended-spectrum Beta-lactamase-producingEscherichia coli

A 75-year-old female was transferred to our clinic three days after uneventful phacoemulsification with intraocular lens (IOL) implantation in the right eye that had been carried out at a local clinic. Under the diagnosis of postoperative endophthalmitis, the patient underwent pars plans vitrectomy, IOL explantation, silicone oil tamponade, and intravitreal antibiotic injection. Even after the procedure, the patient's condition was further aggravated, and extended-spectrum beta-lactamase-producing Escherichia coli were identified on bacterial identification test. Although meropenem was applied locally and systemically, the patient had no-light perception visual acuity.

BACILLUS LICHENIFORMIS AS A CAUSE OF DELAYED-ONSET RECURRENT PSEUDOPHAKIC ENDOPHTHALMITIS—A RARE CASE REPORT

To report a case of delayed-onset recurrent pseudophakic endophthalmitis caused by Bacillus licheniformis. Retrospective review of a case. A 30-year-old lady (s/p pseudophakia 10 years) presented with features of acute endophthalmitis and a vision of light perception in the left eye. She had received 15 intravitreal injections and systemic corticosteroids earlier for similar complaints. A core vitrectomy and intravitreal antibiotics injection improved her vision to 20/70, although the symptoms recurred a week later. Intraocular lens explantation with a repeat vitrectomy and intravitreal antibiotics was performed. The vitreous/aqueous fluid on both occasions grew B. licheniformis sensitive to fluoroquinolones, vancomycin, and gentamicin. One year after the second surgery, her vision was 20/30 with a quiet eye. This case shows that delayed-onset recurrent endophthalmitis after cataract extraction may be caused by Bacillus spp. and, despite sensitivity to most antibiotics, may require intraocular lens explantation for eradication of the infection.

Boston Type 1 Keratoprosthesis Combined With Silicone Oil for Treatment of Hypotony in Prephthisical Eyes

To present the outcomes of Boston type I keratoprosthesis (KPro) implantation in combination with pars plana vitrectomy (PPV) and silicone oil for the treatment of hypotony in prephthisical eyes. Interventional case series. Thirteen eyes of 13 patients underwent Boston type I KPro implantation, pars plana vitrectomy, and silicone oil placement. Concurrent retinal detachment repair, membrane peel, or intraocular lens explantation were performed if necessary. Inclusion criteria for surgery were eyes with visual acuity worse than 20/400, previous failed penetrating keratoplasty, corneal opacification, visually significant or worsening hypotony, and visual acuity 20/200 or worse in the fellow eye. Outcome measures included Snellen best-corrected visual acuity, anatomic retinal attachment, and complications. At the final follow-up (mean, 24 months; range, 5-66 months), visual acuity was improved in 10 of 13 eyes (77%), stable in 2 of 13 eyes (15%), and decreased in 1 of 13 eyes (8%). All eyes had attached retina with no progression to phthisis bulbi. No intraoperative complications occurred. Postoperative complications included retroprosthetic membrane (7 of 13), KPro melt (1 of 13), KPro leak (1 of 13), KPro infection (1 of 13), vitreous hemorrhage (1 of 13), and retinal detachment (1 of 13). Boston type I KPro implantation in combination with pars plana vitrectomy and intraocular silicone oil fill can improve vision in most prephthisical eyes with hypotony. Structural findings can also improve.

Hydrophilic acrylic intraocular lens optic opacification in a diabetic patient

To report clinicopathologic and ultrastructural feature of one opacified hydrophilic acrylic intraocular lens (IOL) explanted from a diabetic patient. A 48-year-old man underwent trans pars plana vitrectomy and phacoemulsification with implantation of a hydrophilic acrylic lens OS in November 2008. The patient complained of a marked decrease in visual acuity in May 2009 as a result of a milky opalescence of the IOL. Intraocular lens explantation and exchange were performed in August 2009, and the explanted IOL was submitted to our center for detailed pathologic, histochemical and ultrastructural evaluation. It was stained by the von Kossa method for calcium, and also underwent scanning electron microscopy and energy dispersive radiograph spectroscopy to ascertain the nature of the deposits leading to opacification. Opacification of the IOL was found to be the cause of the decreased visual acuity. The opacification involved only the IOL optic, and the haptics was clear. Histochemical and ultrastructural analyses revealed that the opacity was caused by deposition of calcium and phosphate within the lens optic. We believe this report of calcification of the Akreos(®) MI-60 IOL is of clinicopathological importance. Long-term follow-up of diabetic patients implanted with this IOL should be maintained by surgeons and manufacturers.

Visual and clinical outcomes of explantation versus preservation of the intraocular lens during keratoprosthesis implantation

To compare the short-term visual and clinical outcomes of explantation versus preservation of a posterior chamber intraocular lens (PC IOL) during keratoprosthesis implantation. Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, USA. Comparative case series. This study comprised patients who had implantation of an aphakic or a pseudophakic Boston type I keratoprosthesis based on their lenticular status. Only adult patients who were pseudophakic with a PC IOL at the time of surgery and who had at least 1 year of follow-up were included. The postoperative refractive error, uncorrected and corrected visual acuities, and intraoperative and postoperative complications were analyzed. Fifteen patients with an unstable PC IOL had aphakic keratoprosthesis implantation with IOL explantation, and 10 patients had implantation of a pseudophakic keratoprosthesis. The postoperative best-ever visual acuity and magnitude of visual acuity improvement were comparable in the 2 groups. The mean postoperative spherical equivalent refractive error was significantly better in the aphakic group (-0.66 diopter [D] ± 1.59 [SD]) than in the pseudophakic group (-3.25 ± 3.20 D) (P=.04). The rate of postoperative complications in the 2 groups was low (P>.05). In this small short-term study, refractive outcomes were better in aphakic patients than in patients who were left pseudophakic. Although not frequent, posterior segment complications after IOL explantation might necessitate further surgeries and cause decreased visual acuity during long-term follow-up in the aphakic group.

A possible strategy for implanting blue‐blocking intraocular lenses

Editor, Age-related macular degeneration (AMD) is said to be associated with sunlight exposure. This is supported by some epidemiological studies but not others. Epidemiological studies have also shown AMD progression following cataract surgery (Cuthbertson et al. 2009). Lipofuscin is considered a biomarker for cellular ageing and oxidative damage with one fluorophore A2E found in the retinal pigment epithelium (RPE) with peak sensitivity of short wavelength. It is thought to be an important mediator of AMD progression generating reactive oxygen species on photoexcitation and being phototoxic to RPE cells in culture (Algvere et al. 2006). Short wavelength light is absorbed by the ageing crystalline lens and this protective effect is lost following cataract surgery, likely resulting in cellular damage as a result (Algvere et al. 2006). Experimental studies showing the protective nature of a yellow intraocular lens (IOL) against radiation damage between 400 and 500 nm and the peak blue-light hazard of wavelengths at 435–440 nm (ICNIRP 1997) support this hypothesis (Cuthbertson et al. 2009). However the data is experimental and with conflicting evidence from epidemiological studies, the role of sunlight exposure in AMD remains inconclusive. In the 1980s, patients undergoing phacoemulsification surgery were given protection against radiation of wavelengths below 400 nm with clear UVR-blocking IOLs but not the blue-light hazard. Considering the experimental (Ham et al. 1976) and the epidemiological evidence that blue light induces damage in the retina, it is rational to implant a yellow IOL following phacoemulsification surgery, in patients at risk of AMD. However, early theoretical reports suggest yellow IOLs may have an effect on scotopic vision, reducing visual performance and contrast sensitivity when compared to a clear IOL due to blue light absorption. On the other hand, filtering out blue light improves the contrast on the retina in the sense that Rayleigh scattering in the vitreous is inversely proportional to the forth power of the wavelength. With foveal scotopic vision decreasing with age, the loss of blue light in the image caused by yellow IOLs may have an impact on night activities such as walking down stairs. Theoretical comparison between yellow IOLs and a middle aged crystalline lens indicated that the loss of blue light in the image may cause reduced scotopic sensitivity but this may not be clinically significant for scotopic vision and clinical trials with blue blocking IOLs have demonstrated no impact on contrast sensitivity (Cuthbertson et al. 2009). Blue light is said to have a role in the regulation of circadian rhythms which could affect sleep and lead to depression, although it is unclear how clinically relevant this is. Therefore, using clear IOLs with UV filters is also recommended over yellow IOLs further complicating the choice in IOL selection. Ideally, an IOL should have no effect on scotopic sensitivity and circadian rhythm with maximal protective effective against short wavelength phototoxicity. However, each of these scenarios has different peak wavelengths and therefore IOL selection will be a balance of these functions. Thus, clinical trials were not able to demonstrate a negative impact of blue blocking IOLs (Cuthbertson et al. 2009). However, if concern exists one option is to implant a clear IOL in one eye and a yellow IOL in the fellow eye. In a patient with bilateral asymmetrical AMD, we recommend that consideration should be given to implanting the yellow IOL in the eye with less severe disease to minimize AMD progression. The literature reports that most patients do not notice a problem with colour vision having a clear IOL in one eye and a yellow one in the other (Marshall et al. 2005; Algvere et al. 2006). There is only one case report of a patient who required explantation of the yellow IOL due to colour perception problems (Shah & Miller 2005). We anticipate this strategy will help minimize AMD progression and while preserving scotopic vision for patients undergoing cataract surgery if scotopic vision is an issue.

Confirmação do cálculo de lente intraocular através da refração intraoperatória

This paper describes the intraoperative refraction for intraocular lens (IOL) power calculation. Report a case of a 67 year-old male patient reporting a progressive loss of visual acuity in the left eye (OS). Examination revealed best corrected visual acuity (BCVA) of 20/60 (-21,50 -4,00 X 170) related to adherence of silicone oil to the IOL optic. IOL exchange was proposed, however biometry was variable and doubtful. Intraoperative refraction confirmed the IOL power and the patient underwent uneventful IOL explantation and exchange with a three-piece acrylic IOL. After surgery, examination revealed BCVA OS of 20/30 (-1,25 -1,25 X 180). Analysis of explanted IOL confirmed adherence of silicone oil to the IOL optic. Intraoperative refraction is useful to confirm IOL power calculation.

Glistenings and surface light scattering in intraocular lenses

Glistenings are fluid-filled microvacuoles that form within the intraocular lens (IOL) optic when the IOL is in an aqueous environment. They are observed in all types of IOLs but have been mainly associated with hydrophobic acrylic IOLs. Experimental and clinical studies suggest the various hydrophobic acrylic IOLs on the market exhibit different tendencies toward glistenings. Factors influencing glistening formation include IOL material composition, manufacturing technique, packaging, associated conditions such as glaucoma or those leading to breakdown of the blood-aqueous barrier, as well as concurrent use of ocular medications. Although the impact of glistenings on postoperative visual function and the evolution of glistenings in the late postoperative period remain controversial, IOL explantation has rarely been reported. The phenomenon of surface light scattering has also been described in association with hydrophobic acrylic IOLs. Its mechanism of formation is controversial but may be related to long-term phase separation water near the IOL surface, although not seen as microvacuoles. The author has no financial or proprietary interest in any material or method mentioned.

Calcification of Different Designs of Silicone Intraocular Lenses in Eyes with Asteroid Hyalosis

To describe the association between calcification of older and newer designs of silicone intraocular lenses (IOLs) and asteroid hyalosis. Case series with clinicopathologic correlation. Sixteen silicone IOLs explanted because of decreased visual acuity associated with opacifying deposits on the posterior optic surface. All 16 lenses underwent gross and light microscopic analyses. Selected lenses underwent alizarin red staining or scanning electron microscopy coupled with energy dispersive x-ray spectroscopy for elemental composition. Clinical data in each case were obtained by a questionnaire sent to the explanting surgeons. Clinical data in relation to 111 hydrophilic acrylic lenses explanted because of calcification also were assessed for comparison. Deposit morphologic features and location were evaluated under gross and light microscopy. The calcified nature of the deposits was assessed by histochemical staining and surface analyses. Clinical data obtained included age at IOL implantation, gender, implantation and explantation dates, as well as history of neodymium:yttrium-aluminum-garnet laser treatment. The presence of asteroid hyalosis in the affected eye was investigated for the explanted silicone and hydrophilic acrylic lenses. The 16 lenses were of 8 designs manufactured from different silicone materials, which were explanted 9.21+/-3.66 years after implantation. Neodymium:yttrium-aluminum-garnet laser applications performed in 12 cases partially removed deposits from the lens, followed by a gradual increase in their density after the procedures. The presence of asteroid hyalosis was confirmed in 13 cases; no notes regarding this condition were found in patient charts in the other 3 cases. The deposits were only on the posterior optic surface of the silicone lenses and were composed of calcium and phosphate. A history of asteroid hyalosis was not found in relation to any of the 111 cases of postoperative calcification of hydrophilic acrylic lenses. Including this current series, there are 22 cases of calcification of silicone lenses involving 8 designs manufactured from different silicone materials described in the literature. The presence of asteroid hyalosis was confirmed in 86.4% of cases. These findings may be added to the list of pros and cons surgeons consider when selecting or recommending an IOL.

Acute Postoperative Endophthalmitis Caused by Gemella Morbillorum

We present a case of Gemella morbillorum endophthalmitis after uneventful cataract surgery. A 78-year-old woman developed progressive blurring of vision, hypopyon, and vitritis in the precocious postoperatory following cataract surgery. Pars plana vitrectomy and intraocular lens explantation were performed followed by intravitreal injection of vancomycin and ceftazidime. Postoperatively, the patient was given hourly topical fortified vancomycin according to antimicrobial susceptibility testing. At the final follow-up visit 6 months after the initial procedure, visual acuity was 20/50 and no signs or symptoms of endophthalmitis were observed. The undiluted vitreous samples and explanted lens were analyzed. Cultures revealed the growth of G morbillorum, an infrequent opportunistic pathogen. To date, this is the second reported case of postoperative endophthalmitis by this species. Although endophthalmitis is rare, ophthalmologists should be alert to the possibility of patients having endophthalmitis caused by G morbillorum. Especially, it is necessary to be cautious with surgery in patients with recent infections. A review of the medical literature of this rare ocular infection is presented.

Mycobacterium abscessus Endophthalmitis After Descemet's Stripping With Automated Endothelial Keratoplasty

To report the first case of endophthalmitis after Descemet's stripping with automated endothelial keratoplasty caused by Mycobacterium abscessus. Observational case report. An immunocompetent 88-year-old woman presented with endophthalmitis 2 months after a routine Descemet's stripping with automated endothelial keratoplasty resulting in decreased visual acuity and persistent vitreous opacities despite aggressive medical treatment. She underwent eventual pars plana vitrectomy with explantation of the posterior chamber intraocular lens and tube shunt. Operative cultures isolated Mycobacterium abscessus. With continued antibiotic therapy, the endophthalmitis eventually resolved with significant improvement of visual acuity. We report a case of endophthalmitis as a complication of Descemet's stripping with automated endothelial keratoplasty. Although a rare pathogen in endophthalmitis, M. abscessus is difficult to culture and treat. Surgical hypotony combined with contamination of intraoperative materials and/or postsurgical drops are the likely mechanisms of infection.