POSTOPERATIVE PROPIONIBACTERIUM ENDOPHTHALMITIS - TREATMENT STRATEGIES AND LONG-TERM RESULTS

Purpose: Postoperative Propionibacterium endophthalmitis is a conditio n characterized by exacerbations and remissions that has often been ac companied by recurrence after treatment. The purpose of this study is to evaluate the efficacy of initial therapies in preventing recurrent endophthalmitis and to assess the safety of intraocular lens (IOL) exc hange performed during treatment of active endophthalmitis. Methods: T he records of 22 patients with culture-proven Propionibacterium endoph thalmitis treated at one facility were retrospectively reviewed. Resul ts: Two patients presented acutely, were treated with intraocular anti biotic injection alone, and experienced no recurrent inflammation. Twe nty patients presented with chronic, delayed-onset pseudophakic endoph thalmitis. Eight of these were treated initially with intraocular anti biotic injection alone, and recurrent endophthalmitis developed in sev en. Twelve patients with chronic endophthalmitis were initially manage d surgically with either pars plana vitrectomy or IOL exchange. Four o f the 12 experienced recurrent endophthalmitis. Patients undergoing ca psulectomy as part of initial management experienced the lowest rate o f recurrent endophthalmitis. Eight patients eventually underwent total capsulectomy and IOL explantation, seven of whom had IOL exchange. No ne of these eight patients had recurrent endophthalmitis. In seven of the eight, persistent bacterial colonization of the lens capsular remn ants was demonstrated. Conclusions: These data suggest that recurrent Propionibacterium endophthalmitis is due to persistence of viable orga nisms sequestered within lens capsular remnants, and that initial ther apy directed toward surgical removal of these sequestered organisms re sults in a reduced frequency of recurrent endophthalmitis. Intraocular lens exchange with complete capsular removal during active endophthal mitis was not associated with recurrent or persistent endophthalmitis.