Endophthalmitis Prevention, Diagnostic Procedures and Treatment

Endophthalmitis is a severe inflammation of the inner eye's structures, caused by an exogenous or endogenous infection with microorganisms which can multiply rapidly. It occurs most frequently after intraocular surgery. Moreover, it can also be a consequence of a penetrant eye injury or a hematogenous dissemination of microorganisms. The most common pathogens of this inflammation are bacteria, next to fungi and less frequently parasites. 

The occurrence, severity and clinical presentation of endophthalmitis depend on the way of infection, the number and virulence of pathogenic bacteria, as well as the patient's immunity state. The type of endophthalmitis can suggest the possible causative agent. Furthermore, it can help determine therapeutic approach or antibiotics to choose. The more virulent are the causative agents, the early the symptoms and signs of endophthalmitis appear. 

Anterior Vitreous Incarceration after Phacoemulsification Cataract Extraction

Vitreous incarceration is a condition where vitreous is trapped within a wound or incision site. When involving the cornea, vitreous can prolapse into the anterior chamber and pass through a microscopic wound at the location of an incision. A vitreous strandis visible on slit lamp examination and the condition is often associated witha peaked pupil where the vitreous strand contacts the iris. If the vitreous penetrates through all the corneal layers and onto the extra ocular surface, a vitreous wick syndrome develops significantly increasing the risk for endophthalmitis. Vitreous incarceration can also cause pupillary block glaucoma, cystoid macular edema, vitreoretinal traction, and corneal decompensation.

Vitreous wick syndrome has been documented as a cause of delayed onset endophthalmitis. In 1970, Ruiz and Teeters described the condition in eleven patients who presented with delayed-onset endophthalmitis after intracapsular cataract extraction surgery (ICCE) with vitreous prolapse. The protruding vitreous strand prevents the wound from closing and can allow micro-organisms to enter. Anterior vitreous wick syndrome is commonly associated with ICCE but has alsobeen reported in cases of extracapsular cataract extraction (ECCE), after posterior capsulotomies, as well as corneal relaxation incisions.