title: Pathological findings in the lens capsules and intraocular lens in chronic pseudophakic endophthalmitis: an electron microscopy study.
abstract: OBJECTIVE
  The aim of this study was to describe the pathological findings in lens capsules and intraocular lens (IOL) studied by scanning and/or transmission electron microscopy (SEM and TEM, respectively) in a series of four eyes with chronic pseudophakic endophthalmitis (CPE).
  
  
  METHODS
  We performed a retrospective study of four patients presenting CPE in whom surgical treatment with pars plana vitrectomy, capsulectomy with extraction of the IOL, and intravitreous antibiotic therapy was thereafter performed. The extracted IOL and the capsular remains were studied by SEM and/or TEM and microbiologic analysis of aqueous humour and vitreous aspirate was also carried out in all the cases.
  
  
  RESULTS
  The presence of microorganisms was observed in the material analysed in all the cases studied. The use of TEM identified bacterial contamination by Staphylococcus spp and mixed contamination with microorganisms presenting a bacillar morphology suggestive of infection by Propionibacterium acnes in addition to the presence of cocci in the capsular remains. In another two cases, SEM localized colonies of Staphylococcus spp on the surface of the IOL in one case and mixed bacterial colonization with cocci plus filamentous bacteria in the other. The presence of macrophages associated with bacteria was observed in the capsular remains.
  
  
  CONCLUSIONS
  Microorganisms were found in the IOL or the capsular material in the four cases studied, thereby explaining the refractoriness and severity of infection. The possible presence of polymicrobial infections, especially in the cases with filamentous bacteria, also explains the recurrence of infection.
authors.affiliation: Department of Ophthalmology, Hospital Clinic, University of Barcelona, Barcelona, Spain. amadan@clinic.ub.es
authors.forename: A
authors.initials: A
authors.lastname: Adán
authors.forename: R P
authors.initials: RP
authors.lastname: Casaroli-Marano
authors.forename: O
authors.initials: O
authors.lastname: Gris
authors.forename: R
authors.initials: R
authors.lastname: Navarro
authors.forename: E
authors.initials: E
authors.lastname: Bitrian
authors.forename: L
authors.initials: L
authors.lastname: Pelegrin
authors.forename: B
authors.initials: B
authors.lastname: Sanchez-Dalmau
mesh_terms: D000368:Aged; D002908:Chronic Disease; D009877:Endophthalmitis / Q000382:microbiology* / Q000473:pathology; D005260:Female; D006801:Humans; D007903:Lens Capsule, Crystalline / Q000382:microbiology* / Q000473:pathology; D007910:Lenses, Intraocular / Q000382:microbiology*; D008297:Male; D008855:Microscopy, Electron, Scanning / Q000379:methods; D008875:Middle Aged; D011183:Postoperative Complications; D011425:Propionibacterium acnes / Q000302:isolation & purification*; D019591:Pseudophakia / Q000382:microbiology* / Q000473:pathology; D012189:Retrospective Studies; D013210:Staphylococcus / Q000302:isolation & purification*; D014821:Vitrectomy / Q000379:methods