Managing severe endophthalmitis with the use of an endoscope

To demonstrate the value of ophthalmic endoscopy in treating patients with severe vision-threatening endophthalmitis in whom visualization through the anterior ocular structures is compromised.

In this retrospective study of patients with endophthalmitis operated on with the use of an endoscope between 1997 and 2003, demographics, cause of endophthalmitis, preoperative and postoperative vision, comorbid factors, complications, intraoperative retinal appearance, etiology, and additional procedures required were recorded.

Fifteen patients were included. A variety of causes were observed: endogenous endophthalmitis (n=3), penetrating trauma (n=2), post-cataract extraction (n=7), bleb infections (n=2), and post-retinal detachment surgery (n=1). Six-month follow-up is reported. Positive cultures were obtained in all but one case. Several patients had aggressive pathogenic organisms. Eight patients retained useful vision. Six of eight patients without retinal necrosis by endoscopic examination had improved vision, with final visual acuity varying between counting fingers and 20/20. Only 1 of 6 patients with retinal necrosis retained useful vision at 20/50.

The ophthalmic endoscope aids in performing safe, diagnostic, and therapeutic vitrectomy in endophthalmitis. Prognosis is dependent on preoperative visual acuity and retinal appearance seen at the time of endoscopic surgery.