title: Endophthalmitis in patients with retained lens fragments after phacoemulsification.
abstract: OBJECTIVE
  To review the treatment and outcomes of patients presenting with concurrent endophthalmitis and retained lens fragments after phacoemulsification.
  
  
  METHODS
  A retrospective chart review was conducted on patients presenting with culture-proven endophthalmitis and retained lens fragments after phacoemulsification between 1990 and 1994.
  
  
  RESULTS
  Five patients were identified with culture-proven endophthalmitis and retained lens fragments after phacoemulsification. In all patients, coagulase-negative staphylococci were cultured from the vitreous fluid. One patient also had positive cultures for Proteus mirabilis and Escherichia coli. The interval between cataract surgery and treatment ranged from 5 days to 6 months. Echography was beneficial in showing retained lens fragments in five of five patients when media opacities obscured the view of the fundus. Four patients had vitrectomy and removal of retained lens fragments during their initial treatment. The fifth patient was treated with intravitreal antibiotics alone and continued to have marked inflammation, eventually requiring vitrectomy for removal of the retained lens fragments. A final visual acuity of 20/400 or better was achieved in four of the five patients.
  
  
  CONCLUSIONS
  Patients may present with endophthalmitis in the setting of retained lens fragments after phacoemulsification. In such cases, the preferred initial management may be pars plana vitrectomy, removal of retained lens fragments, and injection of intraocular antibiotics. In eyes with endophthalmitis and opaque media, echography is a useful screening modality.
authors.affiliation: Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami School of Medicine, FL 33136, USA.
authors.forename: J E
authors.initials: JE
authors.lastname: Kim
authors.forename: H W
authors.initials: HW
authors.lastname: Flynn
authors.forename: P E
authors.initials: PE
authors.lastname: Rubsamen
authors.forename: T G
authors.initials: TG
authors.lastname: Murray
authors.forename: J L
authors.initials: JL
authors.lastname: Davis
authors.forename: W E
authors.initials: WE
authors.lastname: Smiddy
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D009877:Endophthalmitis / Q000382:microbiology* / Q000628:therapy; D004927:Escherichia coli Infections / Q000209:etiology / Q000628:therapy; D015818:Eye Infections, Bacterial / Q000209:etiology* / Q000628:therapy; D005260:Female; D006801:Humans; D007908:Lens, Crystalline / Q000473:pathology*; D008297:Male; D018918:Phacoemulsification / Q000009:adverse effects*; D011183:Postoperative Complications / Q000473:pathology* / Q000628:therapy; D011512:Proteus Infections / Q000209:etiology / Q000628:therapy; D011513:Proteus mirabilis / Q000302:isolation & purification; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000209:etiology / Q000628:therapy; D013212:Staphylococcus epidermidis / Q000302:isolation & purification; D014792:Visual Acuity; D014821:Vitrectomy; D014822:Vitreous Body / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents