Presumed noninfectious endophthalmitis after cataract surgery

To study the clinical features and results of conservative management in cases of presumed noninfectious endophthalmitis after cataract surgery.

L.V. Prasad Eye Institute, Hyderabad, India.

This retrospective study evaluated cases of presumed noninfectious endophthalmitis occurring after cataract surgery in a hospital-based population. Patients with minimal hypopyon and decreased visual acuity unassociated with pain, lid edema, conjunctival chemosis, corneal abscess, and obvious vitreous involvement were treated conservatively. The mainstays of treatment were topical and systemic steroids. Four eyes with clinical evidence of worsening required surgical intervention. Main outcome measures were resolution of inflammation and final visual acuity.

In 23 of 27 patients, the inflammation resolved with medical therapy alone; 21 had a final visual acuity of 20/50 or better. In 3 of the 4 eyes that had surgery, the culture was positive for low virulent organisms; all had a satisfactory outcome. One eye with preoperative glaucoma developed absolute glaucoma with resolution of inflammation.

Noninfectious endophthalmitis invariably presents with hypopyon and decreased vision unassociated with pain and lid edema. A trial of medical therapy with corticosteroids as the mainstay of treatment is often rewarding. Frequent monitoring and preparation for surgical intervention if required are key.