Treatment of chronic endophthalmitis with medical management in an eye with HumanOptics artificial iris/IOL implant following penetrating injury

Session Details

Session Title: Presented Poster Session: Infection & Imaging

Venue: Poster Village: Pod 2

First Author: : J.Fajardo-Sanchez UK

Co Author(s): :    E. Papamichael   N. Strouthidis   C. Pavesio   C. Wong   R. Angunawela           

Abstract Details

Purpose:

Conventional teaching for treatment of chronic post-operative endophthalmitis involves the surgical removal of all intraocular implants. We describe a case which demonstrates the successful medical treatment of presumed Propionibacterium Chronic endophthalmitis in a patient who underwent complex anterior segment surgery - Penetrating Keratoplasty (PK) with implantation of Artificial iris and Intraocular Lens (IOL) implant.

Setting:

Moorfields Eye Hospital NHS Foundation Trust

Methods:

Case report of a patient with a penetrating eye injury with corneal rupture, traumatic aniridia and aphakia. The patient underwent a PK with anterior vitrectomy, scleral fixated HumanOpticsTM artificial iris - IOL implant and subsequent aqueous drainage tube. The patient developed refractory chronic uveitis treated as inflammatory with 2 microbe negative aqueous samples. Months later, white plaques appeared on the posterior surface of the IOL and explantation of the prosthetic iris\IOL complex was advised due to the clinical presumption of chronic infective endophthalmitis. The patient refused and two intravitreal injections of antibiotics (Amikacin and Vancomycin) were administered.

Results:

The white infiltrates resolved rapidly following the second intravitreal injection of antibiotic. This was commensurate with significant reduction of intraocular infection. Some weeks later the patient presented with reduction in vision and was diagnosed with a macular off retinal detachment. Endoscopic retinal detachment repair was performed with vitrectomy, cryopexy and silicone oil. Post-operatively, the retina is attached and there is no further appearance of infection or inflammation. The corneal graft remains clear.

Conclusions:

Medical management under close supervision may be considered in some cases with post-operative chronic endophthalmitis in unicameral eyes before proceeding with explantation of the intraocular implants. In this case, the artificial iris-IOL complex was preserved with resolution of the infection.

Financial Disclosure:

None