109 - Infected Implants

Summary

This chapter addresses infections associated with artificial devices of a specialized nature. Optimal treatment requires participation of surgical specialists experienced in the management of these difficult infections. This is especially the case for pseudophakic endophthalmitis, in which therapy includes intraocular injections.

INTRAOCULAR LENS-ASSOCIATED INFECTIONS (PSEUDOPHAKIC ENDOPHTHALMITIS)

Cataract surgery is one of the most commonly performed operations in the United States. More than 1 million intraocular lenses are implanted each year. Pseudophakic endophthalmitis is a serious complication after cataract surgery, and despite modern pharmacological and surgical methods, its treatment is still difficult and may threaten visual acuity. Fortunately, the incidence of pseudophakic endophthalmitis is very low. Pseudophakic endophthalmitis is thought to occur as a consequence of contamination with flora of the conjunctival sac or lid margin at the time of surgery. There also have been reports of infections arising from contamination of lenses and neutralizing and storage solutions.

The differential diagnosis of endophthalmitis following cataract extraction includes sterile inflammation as well as bacterial and fungal infection. The most common presenting signs and symptoms include pain in the involved eye, decreased visual acuity, red eye, lid edema, hypopyon, and absent or poor red reflex. A single bacterial strain is usually isolated; the most common pathogen is a coagulase-negative staphylococcus (approximately 50% in one large series) followed by Staphylococcus aureus. Virtually any microorganism can be implicated.