[Acute and chronic inflammatory reactions following implantation of artificial lenses]

Inflammatory reactions following IOL-implantation are being caused by different factors. A recent finding refers to the fact that bacteria of usually low pathogenity (i.e. Probionibacterium acnes, Staph. epidermidis, Staph. aureus haemolyticus) can enter the eye during implantation into the capsular bag and can cause an initially localized endophthalmitis. Previously this clinical appearance had frequently been mistaken as a "Toxic Lens Syndrome". Clinically, a persisting or increasing fibrin reaction with or without hypopyon, a typical whitish appearance of the capsule and a more or less marked vitreous infiltration up to a generalized endophthalmitis may be observed. For diagnostic purposes an isolation of germs from the fibrin network in the pupillary area or from the excised fragments of the capsular bag can be successful. Therapy of choice are locally applied antibiotics (i.e. the combination of Cephalosporin with Tobramycin) or eventually an operative intervention. If this is performed in the early course, the IOL can be saved in the majority of cases, although the visual acuity is usually reduced. Postoperative inflammatory reactions can also be caused by individual disposition (pseudoexfoliation, glaucoma, uveitis). No importance is being attributed furthermore to diagnoses like "Toxic Lens Syndrome" or "Pseudo-phako-anaphylactic Endophthalmitis'. Postoperative inflammatory reactions can be divided into five different clinical courses. In cases of bacterial contamination the prognosis is worsened by mono-steroid therapy.