Skip to main content
Erschienen in: Graefe's Archive for Clinical and Experimental Ophthalmology 9/2009

01.09.2009 | Cataract

Lens capsular bag irrigation for low-grade endophthalmitis

verfasst von: Frank C. Schlichtenbrede, Ulrich H. M. Spandau, Björn Harder, Jost B. Jonas

Erschienen in: Graefe's Archive for Clinical and Experimental Ophthalmology | Ausgabe 9/2009

Einloggen, um Zugang zu erhalten

Abstract

Purpose

In postoperative low-grade endophthalmitis, microorganisms of low pathogenicity exhibit prolonged survival times by sequestration into the capsular bag. Thus, removal or irrigation of the capsular bag as nidus of the microorganisms is an essential therapeutic step. Correspondingly, guidelines suggest pars plana vitrectomy, capsulectomy and/or intraocular lens removal. Here, we report on capsular bag irrigation alone as an alternative, minimally invasive therapeutic method for postoperative infectious low-grade endophthalmitis.

Methods

Nine patients consecutively presenting with whitish precipitates in the capsular bag, anterior chamber inflammation and mild vitritis 2 weeks to 6 months following uncomplicated cataract surgery were included. Using an irrigation/aspiration cannula, synechiae were opened, the intraocular lens was rotated within the intact capsular bag and irrigated with 30 ml Ringer’s solution containing 0.16 mg/ml gentamicin and 0.04 mg/ml vancomycin in topical anaesthesia.

Results

In all patients, the inflammation subsided within 2 days to 2 weeks. Visual acuity improved in all patients, mostly to post cataract surgery levels. Visual acuity remained stable during follow-up ranging from 2 to 39 months. No further interventions were required.

Conclusions

The results suggest that capsular bag irrigation as first and single surgical step can be a useful, minimally invasive procedure in the surgical armamentarium for the treatment of infectious low-grade endophthalmitis. It may avoid removal of the intraocular lens and reduce the surgical risks of more complex procedures.
Literatur
1.
Zurück zum Zitat Abreu JA, Alió JL, Cordovés LM, Ferrer C (2006) The ESCRS study on antibiotic prophylaxis for endophthalmitis following cataract surgery. Arch Soc Esp Oftalmol 81:627–630PubMedCrossRef Abreu JA, Alió JL, Cordovés LM, Ferrer C (2006) The ESCRS study on antibiotic prophylaxis for endophthalmitis following cataract surgery. Arch Soc Esp Oftalmol 81:627–630PubMedCrossRef
2.
Zurück zum Zitat Barry P, Seal DV, Gettinby G, Lees F, Peterson M, Revie CW, ESCRS Endophthalmitis Study Group (2006) ESCRS study of prophylaxis of postoperative endophthalmitis after cataract surgery: preliminary report of principal results from a European multicenter study. J Cataract Refract Surg 32:407–410. doi:10.1016/j.jcrs.2006.02.021 PubMedCrossRef Barry P, Seal DV, Gettinby G, Lees F, Peterson M, Revie CW, ESCRS Endophthalmitis Study Group (2006) ESCRS study of prophylaxis of postoperative endophthalmitis after cataract surgery: preliminary report of principal results from a European multicenter study. J Cataract Refract Surg 32:407–410. doi:10.​1016/​j.​jcrs.​2006.​02.​021 PubMedCrossRef
3.
Zurück zum Zitat Endophthalmitis Study Group, European Society of Cataract and Refractive Surgeons (2007) Prophylaxis of postoperative endophthalmitis following cataract surgery: results of the ESCRS multicenter study and identification of risk factors. J Cataract Refract Surg 33:978–988. doi:10.1016/j.jcrs.2007.02.032 CrossRef Endophthalmitis Study Group, European Society of Cataract and Refractive Surgeons (2007) Prophylaxis of postoperative endophthalmitis following cataract surgery: results of the ESCRS multicenter study and identification of risk factors. J Cataract Refract Surg 33:978–988. doi:10.​1016/​j.​jcrs.​2007.​02.​032 CrossRef
4.
Zurück zum Zitat Endophthalmitis Vitrectomy Study Group (1995) Results of the Endophthalmitis Vitrectomy Study. A randomized trial of immediate vitrectomy and of intravenous antibiotics for the treatment of postoperative bacterial endophthalmitis. Arch Ophthalmol 113:1479–1496 Endophthalmitis Vitrectomy Study Group (1995) Results of the Endophthalmitis Vitrectomy Study. A randomized trial of immediate vitrectomy and of intravenous antibiotics for the treatment of postoperative bacterial endophthalmitis. Arch Ophthalmol 113:1479–1496
5.
Zurück zum Zitat Bartz-Schmidt KU, Bermig J, Kirchhof B, Wiedemann P, Walter P, Heimann K (1996) Prognostic factors associated with the visual outcome after vitrectomy for endophthalmitis. Graefes Arch Clin Exp Ophthalmol 234(Suppl 1):51–58. doi:10.1007/BF02343048 CrossRef Bartz-Schmidt KU, Bermig J, Kirchhof B, Wiedemann P, Walter P, Heimann K (1996) Prognostic factors associated with the visual outcome after vitrectomy for endophthalmitis. Graefes Arch Clin Exp Ophthalmol 234(Suppl 1):51–58. doi:10.​1007/​BF02343048 CrossRef
8.
Zurück zum Zitat Busin M (1996) Antibiotic irrigation of the capsular bag to resolve low-grade endophthalmitis. J Cataract Refract Surg 22:385–389PubMed Busin M (1996) Antibiotic irrigation of the capsular bag to resolve low-grade endophthalmitis. J Cataract Refract Surg 22:385–389PubMed
9.
Zurück zum Zitat Gopal L, Nagpal A, Verma A (2008) Direct aspiration of capsular bag material in a case of sequestered endophthalmitis. Indian J Ophthalmol 56:155–157PubMedCrossRef Gopal L, Nagpal A, Verma A (2008) Direct aspiration of capsular bag material in a case of sequestered endophthalmitis. Indian J Ophthalmol 56:155–157PubMedCrossRef
10.
Zurück zum Zitat Monnet D, Labetoulle M, Lautier-Frau M, Offret H, Frau E (2002) Therapeutic strategy in delayed postoperative endophtalmitis: a report on 15 cases. J Fr Ophtalmol 25:599–603PubMed Monnet D, Labetoulle M, Lautier-Frau M, Offret H, Frau E (2002) Therapeutic strategy in delayed postoperative endophtalmitis: a report on 15 cases. J Fr Ophtalmol 25:599–603PubMed
12.
Zurück zum Zitat Arsan AK, Sizmaz S, Ozkan SB, Duman S (1995) Corynebacterium minutissimum endophthalmitis: management with antibiotic irrigation of the capsular bag. Int Ophthalmol 19:313–316. doi:10.1007/BF00130928 PubMedCrossRef Arsan AK, Sizmaz S, Ozkan SB, Duman S (1995) Corynebacterium minutissimum endophthalmitis: management with antibiotic irrigation of the capsular bag. Int Ophthalmol 19:313–316. doi:10.​1007/​BF00130928 PubMedCrossRef
13.
Zurück zum Zitat Camesasca FI, Bianchi C, Beltrame G, Caporossi A, Piovella M, Rapisarda A, Tassinari G, Zeppa L, Italian Betamethasone–Chloramphenicol vs Dexamethasone–Tobramycin Combination Study Group (2007) Control of inflammation and prophylaxis of endophthalmitis after cataract surgery: a multicenter study. Eur J Ophthalmol 17:733–742PubMed Camesasca FI, Bianchi C, Beltrame G, Caporossi A, Piovella M, Rapisarda A, Tassinari G, Zeppa L, Italian Betamethasone–Chloramphenicol vs Dexamethasone–Tobramycin Combination Study Group (2007) Control of inflammation and prophylaxis of endophthalmitis after cataract surgery: a multicenter study. Eur J Ophthalmol 17:733–742PubMed
Metadaten
Titel
Lens capsular bag irrigation for low-grade endophthalmitis
verfasst von
Frank C. Schlichtenbrede
Ulrich H. M. Spandau
Björn Harder
Jost B. Jonas
Publikationsdatum
01.09.2009
Verlag
Springer-Verlag
Erschienen in
Graefe's Archive for Clinical and Experimental Ophthalmology / Ausgabe 9/2009
Print ISSN: 0721-832X
Elektronische ISSN: 1435-702X
DOI
https://doi.org/10.1007/s00417-009-1085-7

Weitere Artikel der Ausgabe 9/2009

Graefe's Archive for Clinical and Experimental Ophthalmology 9/2009 Zur Ausgabe

Neu im Fachgebiet Augenheilkunde

Open Access 22.02.2024 | Peeling | Originalien

Selektive Vitalfarbstoffe in der Makulachirurgie

Erhöhen sie die Wahrscheinlichkeit der intraoperativen ILM-Identifizierung auch bei einem erfahrenen Operateur?

Update Augenheilkunde

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.