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J. H. Townsend, T. Leng, C. C. Wykoff, A. Lingappan, D. Miller, H. W. Flynn; Management of Endophthalmitis While Preserving the Uninvolved Crystalline Lens. Invest. Ophthalmol. Vis. Sci. 2010;51(13):6040.
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To demonstrate that endophthalmitis in phakic eyes can be successfully treated without removal of the crystalline lens during the active phase of the infection.
A non-comparative, retrospective, consecutive case series. All patients were diagnosed with endophthalmitis between January 1980 and June 2009 at the Bascom Palmer Eye Institute. Patients were identified with culture-positive endophthalmitis whose infection was managed without removal of their crystalline lens. Demographic information, etiology of infection, causative organism, treatment modalities, pre- and post- infection lens status, visual acuity outcomes and duration of follow up were evaluated.
Twenty-four phakic eyes of 22 patients with culture-positive endophthalmitis were successfully treated without removal of the uninvolved crystalline lens. Etiology of infection was endogenous in 13 eyes, post-operative in 9 eyes, and post-traumatic in 2 eyes. Fifteen eyes were treated with pars plana vitrectomy and injection of intravitreal antibiotics. Nine eyes were treated with intravitreal injection of antibiotics alone. After successful treatment, 19 eyes had progression of lens opacification, 3 eyes had stable lens opacification, and 2 eyes maintained clear lenses. With average follow up of 17.5 months, 14 eyes had visual acuity outcomes equal to or better than 20/80. Sixty-seven percent (10/15) of eyes treated with vitrectomy and injection of intravitreal antibiotics and 44% (4 of 9) of eyes treated with injection of antibiotics alone achieved 20/80 or better vision.
In the current study, successful treatment of endophthalmitis was often achieved while preserving the uninvolved crystalline lens while the disease was active. There may be an associated progression of lens opacification, but cataract surgical techniques can be performed at a later time.
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