Endophthalmitis

Corneal infiltrate with overlying epithelial defect post penetrating keratoplasty. 

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.