Treatment of Endophthalmitis With Preservation of the Uninvolved Crystalline Lens

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:

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 Number of Patients Degree of Progression

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 • Biro Z, Kovacs B. Results of cataract surgery in previously vitrectomized eyes. J Cataract Refract Surg 2002; 28:1003–1006. Published of the infection. • de Bustros S, Thompson JT, Michels RG, Enger C, Rice TA, Glaser BM. Nuclear sclerosis after vitrectomy for idiopathic epiretinal membranes. Am J Ophthalmol. 1988 Feb 15;105(2):160-4. • Endophthalmitis Vitrectomy Study Group. Results of the Endophthalmitis Vitrectomy Study. A randomized trial of immediate vitrectomy and of intravenous antibiotics for the treatment of postoperative bacterial endophthalmitis. Arch Ophthalmol. 1995 Dec;113(12):1479-96. • Huang SS, Brod RD, Flynn HW Jr. Management of endophthalmitis while preserving the uninvolved crystalline lens. Am J Ophthalmol. 1991 Dec 15;112(6):695-701. • Shousha MA, Yoo SH. Cataract surgery after pars plana vitrectomy. Curr Opin Ophthalmol. 2010 Jan;21(1):45-9. • Smiddy WE, Feuer W. Incidence of cataract extraction after diabetic vitrectomy. Retina. 2004 Aug;24(4):574-81.