Pars plana vitrectomy and injection of intravitreal and endocapsular vancomycin are therapeutic in many cases of chronic postoperative bacterial endophthalmitis. However, this treatment may not completely eradicate the infection, especially if equatorial lens capsule sequestrae of bacteria are present. In such cases, IOL explantation, complete capsulectomy, and intravitreal vancomycin injection is curative. The decision to explant the IOL is made on a case-by-case basis and is based on the clinical course, the severity of the intraocular inflammation, and the level of vision loss. There is no preferred method for treating this condition, but existing literature suggests that more than one surgery may be necessary to eradicate this chronic infection.
The treatment of chronic fungal endophthalmitis is more difficult and requires the use of weekly intravitreal antifungal injections (amphotericin or voriconazole) and, possibly, systemic antifungal drugs in the most severe cases. In vitrectomized eyes, antifungals are often injected twice a week. Multiple vitrectomies may be necessary. The role of systemic therapy in this chronic form of fungal endophthalmitis is not well established or proven.
Clark WL, Kaiser PK, Flynn HW Jr, Belfort A, Miller D, Meisler DM. Treatment strategies and visual acuity outcomes in chronic postoperative Propionibacterium acnes endophthalmitis. Ophthalmology. 1999;106(9):1665–1670.
Excerpted from BCSC 2020-2021 series: Section 9 - Uveitis and Ocular Inflammation. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.