- Clinical features:
- Rare complication and may occur early or late postoperatively.
- Symptoms: reduced vision, hyperemia, ocular pain or chemosis
may be misinterpreted as postoperative inflammatory reaction.
- Signs:
- May present with conjunctival injection and chemosis
- Corneal edema
- Corneal infiltrate or abscess
- Anterior chamber reaction i.e. cells, flare, fibrin or hypopyon,
vitritis
- May be complicated with retinal involvement
- Risk factors: organisms from conjunctiva or lids, broken or loose
sutures, concomitant anterior vitrectomy, aphakia, previous inflammation
or surgery, contaminated donor material (obtained from patients dying
from systemic infection / sepsis) or corticosteroid use.
- Management:
- Thorough ocular examination (day 1 and 1 week postoperatively)
for recognizing objective signs of corneal infiltrate, vitreous
clouding and/or hypopyon is crucial.
- Early recognition of this complication is very important so
that immediate treatment should be initiated and devastating visual
consequences could be prevented.
- Broad-spectrum antibiotics such as gentamicin, streptomycin
and vancomycin have been routinely added to corneal storage media
to help minimizing this postoperative complication.
- Instillation of topical 5% povidone-iodine solution into the
cul-de-sac preoperatively.
- Should endophthalmitis be suspected, diagnostic and therapeutic
measures have to be performed, including cultures and intravitreal
antibiotics.
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