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Chronic postoperative endophthalmitis
Last reviewed: 07.07.2025
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Late chronic sluggish endophthalmitis develops in case of retention of a low-virulence pathogen in the capsular bag. The onset of the disease varies from 4 weeks to several years (on average 9 months) after surgery and, as a rule, is a consequence of conventional cataract extraction with implantation of a ZK-IOL. In rare cases, the pathogen may exit from the posterior chamber into the vitreous body after YAG laser capsulotomy. The pathogens 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 may be accompanied by floating opacities without pain syndrome.
Gonioscopy under mydriasis should be performed to detect opacities at the equator.
Unfortunately, sometimes the pathogen is not detected, for example, due to its low pathogenicity, and this requires 10-14 days to obtain growth. Detection of the pathogen is much more effective when using 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 administration of corticosteroids and the use of antibiotics provide a short-term effect.
- Intravitreal administration of vancomycin (1 mg in 0.1 ml), sometimes in combination with vitrectomy, is effective in 50% of cases.
- Over time, it may be necessary to remove the capsular bag, remnants of the cortical mass, and the intraocular lens. Secondary implantation of the intraocular lens is possible at a later date.