Chronic postoperative endophthalmitis
Last reviewed: 25.06.2018
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Late chronic sluggish endophthalmitis develops in the event of a delayed malovirulent pathogen in the capsular sac. The onset of the disease varies from 4 weeks to several years (an average of 9 months) after surgery and, as a rule, is a consequence of the usual extraction of cataracts with the implantation of ZK-IOL. In rare cases, the pathogen can exit the posterior chamber into the vitreous after YAG laser capsulotomy. The causative agents are most often Propionihacterium acnes, and sometimes Staph. Epidermidis, Actinomyces israelii and Corynebacterium spp.
[Symptoms of chronic postoperative endophthalmitis
Late chronic sluggish endophthalmitis is manifested by a slow progressive decrease in visual acuity, which can be accompanied by floating opacities without pain syndrome.
It is necessary to carry out gonioscopy under mydriasis to detect turbidity at the equator.
Unfortunately, sometimes the pathogen is not detected, for example, because of its low pathogenicity, and this requires 10-14 days to grow. Detection of the pathogen is much more effective when using a polymerase chain reaction.
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Treatment of chronic postoperative endophthalmitis
Treatment of chronic postoperative endophthalmitis is complicated by the fact that the accumulations of the pathogen are isolated from the effects of the body's defenses and antibiotics.
- Local and parabulbar appointment of corticosteroids and the use of antibiotics give a short-lived effect.
- Intravitreal administration of vancomycin (1 mg in 0.1 ml), sometimes in combination with vitrectomy, is effective in 50% of cases.
- In time, it may be necessary to remove the capsule bag, the remnants of cortical masses, the intraocular lens. Secondary implantation of the intraocular lens is possible at a later date.