Lens capsular bag irrigation for low-grade endophthalmitis

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.

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.

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.

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.