Efficacy of Intraocular Lens Explantation in Managing Post-cataract Surgery Endophthalmitis Involving Pseudomonas aeruginosa and Enterococcus faecalis Biofilms:Case Report
10.21561/jor.2024.9.2.199
- Author:
EunAh KIM
1
;
Chan Ho CHO
Author Information
1. Department of Ophthalmology, Samsung Changwon Hospital, Sungkyunkwan University College of Medicine, Changwon, Korea
- Publication Type:CASE REPORT
- From:
Journal of Retina
2024;9(2):199-203
- CountryRepublic of Korea
- Language:English
-
Abstract:
Purpose:This report explores the necessity of intraocular lens (IOL) explantation in the treatment of acute post-cataract surgery endophthalmitis by presenting a case of endophthalmitis caused by Pseudomonas aeruginosa and Enterococcus faecalis, which was successfully treated with early vitrectomy and IOL explantation.Case summary: A 48-year-old non-diabetic male was referred from a local clinic with endophthalmitis two days after uncomplicated cataract surgery. The vision in the affected eye was limited to hand motion; and slit-lamp examination revealed 4+ anterior chamber cells, flare, and hypopyon. B-scan ultrasonography showed dense vitreous infiltration behind the IOL. Initial treatment involved vitrectomy;thorough removal of exudate from the anterior vitreous, pars plana, and ciliary bodies; irrigation of the anterior chamber; and intravitreal antimicrobial injections. Although the endophthalmitis initially improved, recurrence occurred 20 hours post-vitrectomy. Explantation of the IOL and lens capsule, along with silicone oil tamponade, was performed during a second vitrectomy. Microbiological analysis identified P. aeruginosa in the vitreous sample and E. faecalis in the IOL and lens capsule. Two months later, the silicone oil was removed; and a new IOL was implanted via scleral fixation. The patient achieved a final visual acuity of 20/20 seven months postoperatively. The endophthalmitis did not recur.
Conclusions:Primary explantation of the IOL and lens capsule can be considered in cases with discernible exudation around the pars plana, ciliary bodies, and anterior vitreous as these findings may indicate infection by biofilm-forming pathogens on the IOL surface.
