Scanning electron microscope of for endophthalmitis case

PURPOSE: The purpose of this study was to demonstrate the usefulness of the scanning electron microscope in examining the posterior capsule and an intraocular lens (IOL) in an endophthalmitis patient. METHODS: The patient was a 77-year-old man with diabetes mellitus undergoing radiotherapy for prostatic carcinoma, and having a history of esophageal cancer. Phacoemulsification, aspiration and IOL insertion by keratotomy were carried out. The operation was performed without complications. The IOL was a one-piece acrylic type. However, after 24 hours, we diagnosed acute bacterial endophthalmitis, because the patient showed visual loss, high intraocular pressure, fibrin formation, and an increase of cells in the anterior chamber. Vitrectomy to remove the IOL and posterior capsule was carried out on the same day. The removed samples were observed by scanning electron microscope. RESULTS: Enterococcus faecalis was detected in the vitreous and aqueous humor. The bacteria adhered to the optic and haptic surfaces and showed biofilm formation. The traces of the end mill cutting line were recognized beside the haptics. However, the posterior capsule showed no bacterial adhesion but had an unusual shape. CONCLUSIONS: We observed the biofilm formation in an IOL removed from an acute bacterial endophthalmitis case. An IOL may be an important canse of bacterial proliferation and adhesion.