INTRAOCULAR-LENS REMOVAL FROM EYES WITH CHRONIC LOW-GRADE ENDOPHTHALMITIS

Intraocular lenses (IOLs) were removed from 11 eyes with chronic low-g rade endophthalmitis after cataract extraction to restore useful visio n and prevent recurrence. One anterior chamber lens, one iris-supporte d lens, and nine posterior chamber lenses were removed. In the eyes wi th posterior chamber lenses, the posterior capsule was intact; total ( n = 7) or partial (n = 2) capsulectomy was performed in these eyes. Aq ueous humor specimens obtained at surgery were positive for bacteria i n five eyes, but scanning electron microscopy showed bacteria on all r emoved IOLs and capsular bags. Final best corrected visual acuity was 20/40 or better in seven eyes. Reduced visual acuity, between 20/50 an d 20/400 in three eyes and counting fingers in one eye, was related to retinal detachment (n = 2) and age-related macular degeneration (n = 2). Transient hyphema was seen in one eye. With a mean follow-up of 21 months (range 10 to 31 months), no recurrence of inflammation was obs erved. The results show that negative cultures do not preclude a bacte rial cause for infection and that primary IOL removal with partial or total capsulectomy provides a surgical approach to the treatment of ch ronic low-grade endophthalmitis not responsive to medical therapy.