Chronic postoperative endophthalmitis after phacoemulsification: a case-based review of diagnosis and treatment

Chronic postoperative endophthalmitis is a rare infectious complication following cataract surgery and develops 6 weeks or more later. Conservative therapy and even vitrectomy with intraocular lens (IOL) retention may provide only a temporary effect, because the “IOL–capsular bag” complex can remain a reservoir of infection.

The aim. To demonstrate the surgical and medical treatment experience of recurrent chronic postoperative endophthalmitis.

Materials and Methods. We report a clinical case of chronic postoperative endophthalmitis that manifested one month after cataract phacoemulsification with IOL implantation. Despite conservative therapy, sustained remission could not be achieved. Management was comprehensive and included three staged surgical procedures: subtotal pars plana vitrectomy with intravitreal antibiotic injection; revision of the vitreous cavity with removal of the “IOL–capsular bag” complex, repeated intravitreal antibiotics, and silicone oil tamponade (performed after recurrence of inflammation); and silicone oil removal followed by implantation of a three-piece IOL using the Yamane sutureless intrascleral fixation technique (performed 6 months after the previous procedure once inflammation had completely resolved).

Results. Following the first stage of treatment, uncorrected visual acuity (UCVA) was 0.4. A short-term remission of the inflammatory process lasting four weeks was achieved. A subsequent exacerbation served as an indication for the second stage of surgical intervention. Removal of the IOL-capsular bag complex combined with silicone oil tamponade of the vitreous cavity led to a sustained resolution of inflammation. Subsequently, aphakia correction was performed simultaneously with silicone oil removal. Over the two-year postoperative follow-up period, UCVA reached 0.8, with no recurrence of inflammation.

Conclusion. In recurrent chronic postoperative endophthalmitis, the most effective strategy is pars plana vitrectomy with removal of the “IOL–capsular bag” complex. Secondary posterior chamber IOL implantation using the Yamane sutureless intrascleral fixation technique is an effective method for aphakia correction in this setting.

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