Emergent vitrectomy combined with lensectomy, silicone oil temponade for endogenous endophthalmitis

Objective To observe the effect of emergent vitrectomy combined with lensectomy,silicone oil temponade for endogenous endophthalmitis. Methods The clinical data of 28 patients (30 eyes)with endogenous endophthalmitis were analyzed retrospectively. All patients had no history of ocular trauma and intraocular surgery history. There were 21 patients without systemic symptoms, three patients with fever, two patients with eye pain and headache, and two patients with abdominal pain when presentation.All patients diagnosed by best corrected visual acuity, intraocular pressure, slit-lamp microscopy, direct and indirect ophthalmoscope examination and intraocular B-ultrasound examination. Emergent surgery (vitrectomy, lensectomy, silicone oil temponade) was performed in all 30 patients, those with fever or abdominal pain was also treated by relevant clinical departments. Vitreous purulence was taken in all patients before vitrectomy for bacterial, fungal culture and drug sensitivity test. The follow-up was 18 to 30 months. The preoperative and postoperative visual acuity, intraocular pressure and eye retention situation were observed. Results Endophthalmitis was controlled in 28/30 eyes (93.3%) after surgery, recurrent vitreous empyema occurred in 2/30 eyes (6.7%). Evisceration was performed on those two eyes as uncontrolled intraocular pressure. The visual acuity improved significantly at one month and 18 months after surgery (x2 = 19.87, 32. 44; P ＜ 0.01). Postoperative intraocular pressure was normal in 24 eyes (80.0%), transient elevated and controlled in six eyes (x2 = 7.43; P＜0. 05). 12/28 (42.9%) vitreous samples were positive for pathogen culture, including 7/12 (58. 3%) positive for bacteria, 5/12 (41.7%)positive for fungi. There are 18/28 patients (64.3%) also had hepatobiliary system infections. Conclusion Emergent vitrectomy combined with lensectomy, silicone oil temponade is effective for endogenous endophthalmitis. Key words: Endophthalmitis/surgery;  Endophthalmitis/etiology;  Vitrectomy;  Silicone oils/therapeutic use