Chronic Endophthalmitis after Cataract Phacoemulsification. Сlinical Case

Abstract

A clinical case of chronic postoperative endophthalmitis treatment after cataract phacoemulsification is described in the article. The patient received vitrectomy with lens posterior capsule discission and tamponade of vitreal cavity by perfluororganic compound (up to 14 days) and 1mg vancomicin +2.25 mg ceftazidim intravitreally, also anterior chamber washing by 0.5 ml saline containing 5 mg vancomicin. Anterior chamber washing by antibiotics and intravitreal injection of antibacterial medicine combination was repeated on the second and third day after the surgery. This tactics of treatment allowed to save lens capsular bag and intraocular lens. Purpose. To assess efficacy and safety of new treatment method in the patient with chronic postoperative endophthalmitis. Patient B, 65 years old applied to clinic with complaints on the pain in the right eye, visual acuity decrease up to finger counting near face. Symptoms started to disturb in 2 weeks after cataract extraction with IOL implantation. During 6 months courses of antibacterial therapy including vancomicin (antibiotic of reserve) there were no positive dynamics. Cornea edema, multiple precipitates at endothelium and intraocular lens were defined at biomicroscopy; 2.5 mm hypopyon in anterior camera; fibrin in pupil projection; exudation in vitreous cavity. Laser tyndalmetry data (albumen flow in anterior chamber) confirmed inflammation strong enough — 173 f/ms. Surgical treatment according the described method was rendered to the patient. In the postoperative period we saw stable visual functions, uncorrected visual acuity was 0.6, corrected — 0.8. Patient noted the absence of pain and eye’s reddening decrease. At biomicroscopy we observed considerable inflammation decrease, almost total absence of precipitates at cornea endothelium. Laser tyndalmetry data confirmed inflammation decrease, albumen flow in anterior chamber was 17.6 f/ms. Endothelial cells’ loss after surgery was 142 cells/1 mm2 (5.61 %). According to electrophysiologic investigation and ERG there was no deviation from normal values was revealed. This treatment method allows to restore visual functions rather quickly and can be used in case of inefficient lengthy conservative therapy.

Keywords

• chronic endophthalmitis
• vitrectomy
• vancomicin and ceftazidim intravitreal injection