Specular microscopy follow-up of endophthalmitis after cataract operation

INTRODUCTION: Since the first reports of specular microscopic photographs in vivo of the corneal endothelium, endophthalmitis is said to damage endothelial cells irreversibly. PATIENTS AND METHOD: We controlled 29 eyes 1 to 10 years after endophthalmitis following cataract surgery using specular microscopy. We tried to find out, if endophthalmitis leads to significant endothelial damage and we wanted to describe the in-vivo-cytological follow-up of the implanted lenses. RESULTS: Endothelial cell-density of the eyes with endophthalmitis (n = 29) was 2733/mm2 (+/- 680). In those eyes receiving cataract-surgery without endophthalmitis in the fellow eye (n = 14), the endothelial density was 2851/mm2 (+/- 360). If the fellow eye has had no cataract surgery (n = 13), cell density was 3110/mm2 (+/- 750). Hypopyon-iritis after cataract-surgery did not decrease endothelial cell count significantly more than cataract-surgery without hypopyon-iritis (p > 0.05). At the last control at least one year after surgery, 36% of all IOLs were free of any cellular deposits. There was no case of a foreign-body-reaction. CONCLUSION: In our patients, postoperative endophthalmitis has not led to significant endothelial damage. In none of our patients, endophthalmitis has led to chronic foreign-body reaction against the implant or to granulomatous uveitis. Specular microscopy of the corneal endothelium and of the implanted lens may help to differentiate in the case of postoperative inflammation between an infection and a foreign-body-reaction. In the case of a sterile foreign-body-reaction, there are no inflammatory cells on the endothelium or in the anterior chamber.