1. 1 Justin H. Townsend, MD Harry W. Flynn, Jr., MD The authors have no financial interest in the subject matter of this poster Treatment of Endophthalmitis With Preservation of the Uninvolved Crystalline Lens

2. Background Large studies show endophthalmitis most commonly develops following cataract surgeryLarge studies show endophthalmitis most commonly develops following cataract surgery Endophthalmitis can also develop in phakic eyesEndophthalmitis can also develop in phakic eyes Endogenous spread Endogenous spread Post-operative (glaucoma, PPV) Post-operative (glaucoma, PPV) Post-traumatic Post-traumatic The crystalline lens is often removed via a pars plana lensectomy with PPV during the treatment of endophthalmitisThe crystalline lens is often removed via a pars plana lensectomy with PPV during the treatment of endophthalmitis Evidence is limited regarding the treatment of endophthalmitis without removal of the uninvolved crystalline lensEvidence is limited regarding the treatment of endophthalmitis without removal of the uninvolved crystalline lens The purpose of this study is to demonstrate the successful treatment of endophthalmitis without removal of the uninvolved crystalline lensThe purpose of this study is to demonstrate the successful treatment of endophthalmitis without removal of the uninvolved crystalline lens 2

3. Methods Retrospective, non-comparative case seriesRetrospective, non-comparative case series January 1980 to June 2009January 1980 to June 2009 Bascom Palmer Eye InstituteBascom Palmer Eye Institute Culture-positive endophthalmitis managed without removal of the crystalline lensCulture-positive endophthalmitis managed without removal of the crystalline lens Patient records reviewedPatient records reviewed Demographic information, etiology of infection, presenting clinical features, pathogen identification, treatment modalities, pre- and post-treatment lens status, visual acuity outcome and duration of follow up Demographic information, etiology of infection, presenting clinical features, pathogen identification, treatment modalities, pre- and post-treatment lens status, visual acuity outcome and duration of follow up 3

4. Results 24 phakic eyes of 22 patients were identified24 phakic eyes of 22 patients were identified Etiology of infectionEtiology of infection Endogenous – 13, Post-operative – 9, Post-traumatic – 2 Endogenous – 13, Post-operative – 9, Post-traumatic – 2 Treatment ModalityTreatment Modality PPV + intravitreal Abx – 14 PPV + intravitreal Abx – 14 Intravitreal Abx alone – 10 Intravitreal Abx alone – 10 Average duration of follow up: 18.4 monthsAverage duration of follow up: 18.4 months 7/24 eyes went on to have routine cataract extraction during follow up period7/24 eyes went on to have routine cataract extraction during follow up period No surgeries noted to be complicated No surgeries noted to be complicated Final VAs: 20/20, 20/25, 20/40, 20/60, 20/80, 20/400 (macular scar), 20/100 (macular scar) Final VAs: 20/20, 20/25, 20/40, 20/60, 20/80, 20/400 (macular scar), 20/100 (macular scar) 4

5. Results 5 Culture results:Culture results: Gram+Gram-Fungal Endogenous311 Post-operative63 Post-traumatic11

6. Final visual acuity by etiology of infectionFinal visual acuity by etiology of infection Results 6

7. Final visual acuity by treatment modalityFinal visual acuity by treatment modality Results 7

8. Cataract progression by treatment modalityCataract progression by treatment modality Results 8

9. Results 9 Number of Patients Degree of Progression Degree of cataract progression by treatment modalityDegree of cataract progression by treatment modality

10. Conclusions Successful treatment of endophthalmitis was often achieved while preserving the uninvolved crystalline lensSuccessful treatment of endophthalmitis was often achieved while preserving the uninvolved crystalline lens Progression of cataract was frequently seen in this seriesProgression of cataract was frequently seen in this series Successful treatment of endophthalmitis without removal of the crystalline lens can avoid placement of a posterior chamber intraocular lens in an actively infected eyeSuccessful treatment of endophthalmitis without removal of the crystalline lens can avoid placement of a posterior chamber intraocular lens in an actively infected eye Standard cataract surgical techniques can be used later with good resultsStandard cataract surgical techniques can be used later with good results 10

11. References Biro Z, Kovacs B. Results of cataract surgery in previously vitrectomized eyes. J Cataract Refract Surg 2002; 28:1003–1006. Published of the infection.Biro Z, Kovacs B. Results of cataract surgery in previously vitrectomized eyes. J Cataract Refract Surg 2002; 28:1003–1006. Published of the infection. de Bustros S, Thompson JT, Michels RG, Enger C, Rice TA, Glaser BM. Nuclear sclerosis after vitrectomy for idiopathic epiretinal membranes. Am J Ophthalmol. 1988 Feb 15;105(2):160-4.de Bustros S, Thompson JT, Michels RG, Enger C, Rice TA, Glaser BM. Nuclear sclerosis after vitrectomy for idiopathic epiretinal membranes. Am J Ophthalmol. 1988 Feb 15;105(2):160-4. Endophthalmitis Vitrectomy Study Group. Results of the Endophthalmitis Vitrectomy Study. A randomized trial of immediate vitrectomy and of intravenous antibiotics for the treatment of postoperative bacterial endophthalmitis. Arch Ophthalmol. 1995 Dec;113(12):1479-96.Endophthalmitis Vitrectomy Study Group. Results of the Endophthalmitis Vitrectomy Study. A randomized trial of immediate vitrectomy and of intravenous antibiotics for the treatment of postoperative bacterial endophthalmitis. Arch Ophthalmol. 1995 Dec;113(12):1479-96. Huang SS, Brod RD, Flynn HW Jr. Management of endophthalmitis while preserving the uninvolved crystalline lens. Am J Ophthalmol. 1991 Dec 15;112(6):695-701.Huang SS, Brod RD, Flynn HW Jr. Management of endophthalmitis while preserving the uninvolved crystalline lens. Am J Ophthalmol. 1991 Dec 15;112(6):695-701. Shousha MA, Yoo SH. Cataract surgery after pars plana vitrectomy. Curr Opin Ophthalmol. 2010 Jan;21(1):45-9.Shousha MA, Yoo SH. Cataract surgery after pars plana vitrectomy. Curr Opin Ophthalmol. 2010 Jan;21(1):45-9. Smiddy WE, Feuer W. Incidence of cataract extraction after diabetic vitrectomy. Retina. 2004 Aug;24(4):574-81.Smiddy WE, Feuer W. Incidence of cataract extraction after diabetic vitrectomy. Retina. 2004 Aug;24(4):574-81.