Intraocular lens removal from eyes with chronic low-grade endophthalmitis

Intraocular lenses (IOLs) were removed from 11 eyes with chronic low-grade endophthalmitis after cataract extraction to restore useful vision and prevent recurrence. One anterior chamber lens, one iris-supported lens, and nine posterior chamber lenses were removed. In the eyes with posterior chamber lenses, the posterior capsule was intact; total (n = 7) or partial (n = 2) capsulectomy was performed in these eyes. Aqueous humor specimens obtained at surgery were positive for bacteria in five eyes, but scanning electron microscopy showed bacteria on all removed IOLs and capsular bags. Final best corrected visual acuity was 20/40 or better in seven eyes. Reduced visual acuity, between 20/50 and 20/400 in three eyes and counting fingers in one eye, was related to retinal detachment (n = 2) and age-related macular degeneration (n = 2). Transient hyphema was seen in one eye. With a mean follow-up of 21 months (range 10 to 31 months), no recurrence of inflammation was observed. The results show that negative cultures do not preclude a bacterial cause for infection and that primary IOL removal with partial or total capsulectomy provides a surgical approach to the treatment of chronic low-grade endophthalmitis not responsive to medical therapy.