Management of low grade endophthalmitis by capsular bag irrigation

Aims: Further to topical or intravitreal antibiotics treatment of low grade endophthalmitis (lg-E) usually comprises either pars plana vitrectomy (ppv), capsulectomy or intraocular lens (IOL) removal. Sequestration of microorganisms in the capsular bag (CB) renders intensive antibiotics ineffective. Hence, removal or irrigation of the CB as nidus is curative. Here, we report on CB irrigation as an alternative procedure. Methods: We included 11 patients presenting with whitish precipitates in the CB, anterior chamber inflammation and vitreous body cells 2 days to 10 months after standard cataract surgery with IOL implantation. The CB was irrigated with 30ml of Ringer's solution containing 0.12mg/ml gentamicin and 0.03mg/ml vancomycin in topical anaesthesia. Via a 1-mm paracentesis an irrigation needle was introduced into the anterior chamber, circular adhesions between capsulorhexis and the IOL were opened, and the IOL was rotated within the intact CB. Results: In all patients, the inflammation subsided within 2 days to 3 weeks. Visual acuity improved in all cases, with improvement from counting fingers to 0.8 as best results. During the follow-up period of more than 1,5 years visual acuity remained stable. Conclusions: Our results suggest that antibiotic irrigation of the CB and IOL as minimally invasive procedure may be an alternative in the in the surgical management of postoperative lg-E.