Justin H. Townsend, MD

1
Treatment of Endophthalmitis With Preservation of
the Uninvolved Crystalline Lens

• Justin H. Townsend, MD
• Harry W. Flynn, Jr., MD
• The authors have no financial interest in the
  subject matter of this poster

2
Background

• Large studies show endophthalmitis most commonly
  develops following cataract surgery
• Endophthalmitis can also develop in phakic eyes
• Endogenous spread
• Post-operative (glaucoma, PPV)
• Post-traumatic
• The crystalline lens is often removed via a pars
  plana lensectomy with PPV during the treatment of
  endophthalmitis
• Evidence is limited regarding the treatment of
  endophthalmitis without removal of the uninvolved
  crystalline lens
• The purpose of this study is to demonstrate the
  successful treatment of endophthalmitis without
  removal of the uninvolved crystalline lens

3
Methods

• Retrospective, non-comparative case series
• January 1980 to June 2009
• Bascom Palmer Eye Institute
• Culture-positive endophthalmitis managed without
  removal of the crystalline lens
• Patient records reviewed
• Demographic information, etiology of infection,
  presenting clinical features, pathogen
  identification, treatment modalities, pre- and
  post-treatment lens status, visual acuity outcome
  and duration of follow up

4
Results

• 24 phakic eyes of 22 patients were identified
• Etiology of infection
• Endogenous 13, Post-operative 9,
  Post-traumatic 2
• Treatment Modality
• PPV intravitreal Abx 14
• Intravitreal Abx alone 10
• Average duration of follow up 18.4 months
• 7/24 eyes went on to have routine cataract
  extraction during follow up period
• No surgeries noted to be complicated
• Final VAs 20/20, 20/25, 20/40, 20/60, 20/80,
  20/400 (macular scar), 20/100 (macular scar)

5
Results

• Culture results

Gram Gram- Fungal
Endogenous 3 11
Post-operative 6 3
Post-traumatic 1 1
6
Results

• Final visual acuity by etiology of infection

7
Results

• Final visual acuity by treatment modality

8
Results

• Cataract progression by treatment modality

9
Results

• Degree of cataract progression by treatment
  modality

10
Conclusions

• Successful treatment of endophthalmitis was often
  achieved while preserving the uninvolved
  crystalline lens
• Progression of cataract was frequently seen in
  this series
• Successful treatment of endophthalmitis without
  removal of the crystalline lens can avoid
  placement of a posterior chamber intraocular lens
  in an actively infected eye
• Standard cataract surgical techniques can be used
  later with good results

11
References

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