Postoperative Endophthalmitis Clinical Presentation
- Author: Hemang K Pandya, MD; Chief Editor: Hampton Roy, Sr, MD more...
Patients with acute postoperative endophthalmitis typically present within 6 weeks of intraocular surgery with moderate to severe eye pain and decreased vision.
The hallmark findings on ophthalmic examination are posterior and anterior chamber inflammation.[12, 13, 14]
Hypopyon is present in most cases.[12, 13, 14]
Other important findings include conjunctival hyperemia and chemosis, corneal edema, wound abnormalities, and associated eyelid or orbital inflammation.
In rare circumstances, patients may develop chronic, infectious endophthalmitis months to years after intraocular surgery. These patients exhibit indolent inflammation, which is initially responsive to corticosteroids, but over time, become refractory to therapy. Although conjunctival hyperemia, corneal edema, and anterior and posterior chamber inflammation are often present, rapid deterioration of vision and hypopyon are not seen frequently.[15, 16]
Risk factors for development of postoperative endophthalmitis may include the following:
Increased operative time, low volume (experienced) surgeon 
Posterior capsule rupture/vitreous loss [13, 14]
Retained lens fragments
Inadequate sterilization of the operative field
Contamination of surgical instruments
Inadequate wounds (eg, leaky), as in some cases of sutureless clear corneal cataract incisions and sutureless sclerotomies [5, 6, 18, 19]
In the EVS, a prospective randomized clinical trial that evaluated the management of acute postoperative (cataract extraction or secondary IOL implantation) endophthalmitis, the most common organisms isolated were coagulase-negative staphylococci (70%), Staphylococcus aureus (9.9%), and streptococci species (9.0%). Infections caused by gram-negative organisms were seen in 6% of cases.[1, 20]
Endophthalmitis following other types of intraocular surgery has a similar microbiological profile with the following exceptions:
In filtering bleb-associated cases, the most common offending species is Streptococcus, followed by Haemophilus influenzae and coagulase-negative staphylococci. [13, 21]
In chronic postoperative endophthalmitis, an important causative organism is Propionibacterium acnes, a slow-growing, gram-positive bacillus that is associated with a characteristic white, intracapsular plaque that develops weeks to months and years after cataract surgery. [15, 16, 22]
Coagulase-negative staphylococci, fungal species, and unusual gram-negative organisms also have been reported to cause chronic postoperative endophthalmitis. 
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