Management of endophthalmitis while preserving the uninvolved crystalline lens

Twelve phakic eyes (11 patients) with culture-positive endophthalmitis were treated without removal of the uninvolved crystalline lens. Eight eyes were treated by pars plana vitrectomy and intraocular injection of antibiotics. Four eyes were treated with intraocular antibiotic injection alone. The clinical infection was successfully eradicated in all patients, including one patient treated with reinjection of antibiotics. During follow-up after successful treatment, eight eyes had progression of a preexisting lens opacification, two eyes had stable lens opacification, and two eyes maintained clear lenses. Six of 12 eyes achieved 20/80 or better visual acuity with an average follow-up time of 13 months. Six of eight eyes treated with pars plana vitrectomy and intraocular antibiotic injection achieved this level of visual acuity in contrast to none of four eyes treated with only intraocular antibiotic injection. These results indicated that endophthalmitis in phakic eyes can be successfully treated while preserving a clear, uninvolved crystalline lens by the use of pars plana vitrectomy and intraocular administration of appropriate antibiotics.