Pars-plana-vitrectomy for endophthalmitis treatment and the role of standardized ultrasound.

PURPOSE: Endophthalmitis is a severe inflammation following surgery or endogenous spread of pathogens. Besides clinical signs and symptoms, standardized ultrasound might help to confirm the diagnosis. Thus, we analyzed 172 cases of endophthalmitis for pathogens, visual acuity (VA) and the predictive value of standardized ultrasound. METHODS: Retrospective analysis of patients treated with pars-plana-vitrectomy for endophthalmitis at the University Eye Hospital was performed. Sex, age, VA at presentation, first day after surgery, four weeks postoperatively, and at last follow-up, as well as pathogen culture, and presence of standardized ultrasound before vitrectomy were recorded. Mann-Whitney U and Chi-square tests were used for groupwise comparisons. RESULTS: A total of 172 patients (male = 47.7%) with a median age of 76 years (IQR 65-82 years) treated for endophthalmitis (exogenous = 85.5%) were included. Median follow-up time was 65 days (IQR 12-274 days). Visual acuity at presentation was 2.30 logMAR (IQR 2.70-2.30 logMAR); it increased to 1.00 logMAR (1.4-0.40 logMAR) at last follow-up. A total of 79 patients (45.9%) underwent standardized ultrasound before vitrectomy. Patients with positive ultrasound criteria had a significantly decreased VA at presentation (p = 0.034). Positive microbiological cultures for Streptococcus spp. and Enterococcus faecalis were associated with decreased VA (p = 0.028) at last follow-up. CONCLUSION: Standardized ultrasound is an easy and robust tool in the diagnosis of endophthalmitis. Positive criteria are significantly associated with decreased VA at presentation. The recovery of VA depends on pathogens and is significantly worse for certain species (Streptococcus spp., Enterococcus faecalis).

Immediate Vitrectomy for Acute Endophthalmitis in Patients with a Visual Acuity of Hand Motion or Better.

PURPOSE: To determine the efficacy of immediate pars plana vitrectomy as the primary treatment for acute endophthalmitis in patients with a visual acuity (VA) of hand motion (HM) or better. METHODS: A total of 149 patients who were referred to a single center for acute endophthalmitis after cataract surgery over the 13-year study period were retrospectively analyzed. Only patients presenting with a VA of at least HM were included. Patients were initially treated with either primary vitrectomy or intravitreal antibiotic injection alone, and their visual outcomes and reintervention rates after initial treatment were compared. RESULTS: There was no significant difference in the proportion of good (final VA ≥20 / 40) and poor (VA ≤ counting finger) visual outcomes between the groups. However, subgroup analysis of patients with a VA of HM (92 eyes) showed that the incidence of reintervention (14 of 72 eyes [19.4%] vs. 9 of 20 eyes [45.0%]) and poor visual outcomes (10 of 72 eyes [13.9%] vs. 8 of 20 eyes [40.0%]) were lower after prompt vitrectomy than after intravitreal antibiotic injection alone (p = 0.019 and p = 0.022, respectively). For those with a VA of at least counting finger, no significant difference was observed between the groups. CONCLUSIONS: For patients with endophthalmitis presenting with a VA of HM, performing a prompt vitrectomy reduced the incidence of reintervention and poor visual outcomes than the administration of intravitreal antibiotics alone. Our results suggest that primary vitrectomy for patients with endophthalmitis presenting with a VA of HM could be more beneficial than intravitreal antibiotic injection alone.

A Case of Post-cataract Surgery Endophthalmitis Successfully Treated with Conservative Therapy.

BACKGROUND: Postoperative endophthalmitis after cataract surgery often requires emergency surgery if caused by an infection. However, early reoperation after the surgery put a heavy mental burden on the patient. Here we report a relatively mild case of postoperative endophthalmitis in which emergency surgery was avoided through careful observation including gram stain and culture test. CASE: 87-year-old male. The patient had a sudden decrease in visual acuity on the 4th day after cataract surgery of the left eye performed at another hospital and visited his previous doctor on the following day. Postoperative endophthalmitis was suspected, so he was referred to our department on the same day. The inflammation was observed in the anterior segment of the left eye. The gram staining results for collected anterior aqueous humor were negative. The patient was followed up with continued medication and careful observation without undergoing emergency surgery. The inflammation of the anterior segment subsequently improved. The patient underwent a left vitrectomy three months later to remove residual vitreous opacity. CONCLUSION: Postoperative endophthalmitis after cataract surgery is often indicated for emergency surgery, but there can be cases in which conservative therapy with thorough observation succeeds in retaining visual function.

Early Pars Plana Vitrectomy in Acute Endophthalmitis: The Manchester Series.

BACKGROUND AND OBJECTIVE: Current literature lacks good-quality evidence regarding the outcomes of early pars plana vitrectomy (PPV) for acute exogenous endophthalmitis. The aim for this study was to analyze and discuss the outcomes of PPV for endophthalmitis in a UK tertiary hospital. PATIENTS AND METHODS: This study was a retrospective case series. The clinical records of consecutive patients who had PPV for acute exogenous endophthalmitis were reviewed. Demographic data, etiology, timing of onset, timing of PPV, intraand postoperative complications, baseline and final best-corrected visual acuity (BCVA), therapeutic regimens, and microbiology details were collected. Primary efficacy and safety outcome measures were BCVA improvement of two or more logMAR lines and intra- or postoperative complications, respectively. RESULTS: Forty-one patients with a median age of 76 (interquartile range, 64 to 82) years were studied. The most common etiology was intravitreal injection (41%), followed by phacoemulsification (34%). Median interval to PPV was 1.0 (interquartile range, 1.0 to 3.0) days. In a multivariate model controlling for age, baseline BCVA, microbiology positivity, and etiology (post-intravitreal injection), PPV after 24 hours was seven times more likely to achieve significant BCVA improvement (odds ratio, 7.47; 95% confidence interval, 1.12 to 49.66; P = .038). PPV within 24 hours of presentation was associated with more intraoperative complications. CONCLUSIONS: Favorable outcomes may be achieved with current antibiotic regimens and PPV for endophthalmitis. The series suggests that an early surgical intervention may be associated with poorer functional outcomes. Tap and inject at presentation, followed by a semi-urgent PPV as required, seems to be a sensible approach. [Ophthalmic Surg Lasers Imaging Retina. 2022;53:96-102.].

Better visual outcome associated with early vitrectomy in the management of endophthalmitis.

AIMS: To examine the role of early vitrectomy in the management of endophthalmitis from all causes. METHODS: Retrospective study of 290 consecutive subjects diagnosed with endophthalmitis at Auckland District Health Board between 1 January 2006 and 31 July 2019. Main outcome measure was visual acuity at 9-month follow-up and proportion of subjects with severe vision loss (≤20/200). RESULTS: Median age at presentation was 70.4 years and 151 subjects (52.1%) were women. Cataract surgery was the most common cause of endophthalmitis in 92 subjects (31.7%) followed by intravitreal injection in 57 (19.7%), endogenous endophthalmitis in 48 subjects (16.6%), non-surgical trauma in 42 subjects (14.5%), glaucoma surgery in 24 subjects (8.3%), vitrectomy in 22 subjects (7.6%) and corneal in 5 subjects (1.7%). Culture was positive in 136 (46.9%) with gram-positive organisms most common (76.5%). Early vitrectomy was performed in 82 subjects (28.3%). Median visual acuity at 9 months was 20/100 (IQR 20/30 to light perception), and severe vision loss occurred in 100 (43.5%). Retinal detachment occurred in 35 eyes (12.1%) and 26 eyes were enucleated. On multivariate analysis, younger age, poor presenting visual acuity and culture-positive endophthalmitis were associated with worse outcomes, and early vitrectomy was associated with better outcomes. CONCLUSIONS: Early vitrectomy (within 24 hours) is associated with better visual outcomes at 9 months, while younger age, poor presenting visual acuity and culture-positive endophthalmitis are associated with poorer visual acuity outcomes.

Clinical profile and microbiological trends of therapeutic keratoplasty at a network of tertiary care ophthalmology centers in India.

OBJECTIVE: To describe the clinical profile and microbiology trends in patients undergoing therapeutic keratoplasty at a multi-tier ophthalmology hospital network in India. METHODS: This cross-sectional hospital-based study included 3147 eyes undergoing therapeutic keratoplasty between Jan 2016 and Dec 2020 (5 years period) as cases. The demographic data, clinical profile and microbiological analysis were collected using an electronic medical record system. RESULTS: Of a total of 13,625 eyes with microbial keratitis(non-viral), 3147 (23.1%) underwent therapeutic keratoplasty during the study duration. Majority of patients were males (68.35%), from a rural geography (49.89%) and in 51-60 years age bracket (23.74%). The mean age of the patients was 50.54 ± 15.83 years. Two-thirds of patients were from lower socio-economic strata (66.63%) with an agrarian background (36.51%). Of the 3,147 eyes, fungus (51.8%) was the most common indication of therapeutic keratoplasty followed by bacteria (16.87%) and parasite (1.27%). No organisms could be identified in about a third (29.33%) of the cases. Between 2016 and 2020, the trend of therapeutic keratoplasties for fungal infections steadily grew (39.9% vs 45.49%) while the bacterial infections showed a steady decline (23.15% vs 11.81%). CONCLUSIONS: Medical cure rate was seen in majority of those with microbial keratitis, and 23.1% eventually required management with therapeutic keratoplasty. Fungal keratitis was the most common indication for therapeutic keratoplasty. Male gender, rural setting, low socio-economic background and agricultural occupation are common risk factors for patients undergoing therapeutic keratoplasty in India.

Assessment of Antimicrobial Activity of Dehydrated Amniotic Membrane in Infectious Keratitis: A Small Retrospective Case Series and In Vitro Study.

PURPOSE: To describe a small case series of infectious keratitis with poor visual outcomes after amniotic membrane (AM) placement and to prospectively evaluate whether AM demonstrates antibacterial activity in vitro against pathogens commonly isolated from infectious corneal ulcers. METHODS: A retrospective case series and in vitro study of antibacterial activity of dehydrated AM using disk diffusion and measurement of inhibitory zones for bacterial assessment and inverted microscopy analysis for Acanthamoeba sp. growth. RESULTS: Three cases of known etiology infectious keratitis are described where the clinical presentation worsened after treatment with AM. In vitro analysis of dehydrated AM, with and without a soft contact lens, demonstrated no inhibition of growth against Pseudomonas aeruginosa or Streptococcus pneumoniae. There was minimal growth inhibition of Staphylococcus aureus, although these zones of inhibition were much smaller than that surrounding the positive control. For Acanthamoeba sp., solubilized, dehydrated AM did not alter cyst density. CONCLUSIONS: In an in vitro analysis, dehydrated AM did not provide evidence for a potentially clinically meaningful antibacterial effect against organisms commonly isolated from corneal ulcers.

TAP AND INJECT VERSUS PARS PLANA VITRECTOMY FOR POSTPROCEDURAL ENDOPHTHALMITIS: A Meta-analysis.

PURPOSE: To compare the visual outcomes after prompt pars plana vitrectomy (PPV) with tap biopsy and intravitreal antimicrobial injection to treat postinjection and postsurgery endophthalmitis. METHODS: The Cochrane Central Register of Controlled Trials, Ovid MEDLINE, and Ovid Embase databases were searched for articles published between January 2010 and November 2020. Two independent reviewers selected articles and extracted data. We analyzed data in RevMan 5.3 and assessed methodological quality using the Cochrane ROBINS-I tool. The mean improvement in visual outcome was compared between PPV and intravitreal antimicrobial injection as a relative risk of improving ≥2 lines and a mean logarithm of the minimal angle of resolution difference in improvement. RESULTS: Fifteen retrospective case series (1,355 eyes), of which 739 eyes (55%) received intravitreal antimicrobial injection and 616 (45%) received PPV as initial treatment, were included. The overall relative risk of improving 2 or more lines in PPV in comparison with intravitreal antimicrobial injection was 1.04 (95% CI 0.88-1.23; P = 0.61; I2 = 0%) with a mean difference of 0.04 (95% CI -0.18 to 0.27; P = 0.69; I2 = 0%). The results stayed robust when subgroup analysis based on causative procedure for endophthalmitis was performed. CONCLUSION: Intravitreal antimicrobial injection is noninferior to PPV for the treatment of postcataract operation, postinjection, and post-PPV endophthalmitis.

Mandated IOL Removal for Cure of Recurrent Enterococcus Faecalis Endophthalmitis: A Case Report.

With modern technology and peri-op antibiotic use, postoperative endophthalmitis is uncommon to modern cataract surgery, and its recurrence even more unusual. Enterococcal faecalis endophthalmitis is an acute type of endophthalmitis that is not only rare, but can be recurrent, and has a poor functional prognosis [1]. Since the disease is refractory to conventional therapy, this paper details our experience with treating the disease given the current lack of standard care both medically and surgically.

Surgery combined with antibiotics for the treatment of endogenous endophthalmitis caused by liver abscess.

BACKGROUNDS: Endogenous endophthalmitis is a serious disease caused by intraocular infection that can rapidly progress to cause blindness. This study evaluated the clinical features, surgical and antibiotics treatment strategies, and treatment outcomes in patients with endophthalmitis caused by liver abscess. METHODS: Between April 2014 and April 2019, the clinical data of 16 patients (19 eyes) with endophthalmitis associated with liver abscess who underwent surgery at Shengjing Hospital were retrospectively analyzed. Furthermore, we evaluated the final visual outcomes in the patients to determine the efficacy of surgery. RESULTS: Fifteen patients (18 eyes) underwent intravitreal injection followed by vitrectomy after admission. One patient (1 eye) only underwent intravitreal injection. Of the 16 patients, 3 patients (3 eyes) had recurrent intraocular inflammation and eventually underwent evisceration. Systemic antibiotics were administered for all patients based on the results of vitreous humor culture, blood culture, and antibiotic susceptibility tests. Outpatient follow-ups were performed until the patients were stable (6 months). Of the 19 eyes, 1 eye (5%) had visual acuity restored to 20/200, 6 eyes (31%) had visual acuity restored to counting fingers (CF), 2 eyes (11%) had visual acuity restored to hand motion (HM), 4 eyes (22%) showed only light perception (LP), and the remaining 6 eyes (31%) showed no light perception (NLP). Drug susceptibility tests suggested that the carbapenems exhibited significant effects in the inflammatory reaction. CONCLUSION: Endogenous endophthalmitis caused by liver abscess is a very serious condition, and the final visual outcome is poor. Timely surgical intervention combined with antibiotic treatment is essential, and the primary disease must be treated to control disease progression at the earliest.

Favourable outcome in paediatric endogenous endophthalmitis secondary to Neisseria meningitidis following pars plana vitrectomy.

Paediatric endogenous endophthalmitis is an uncommon but potentially devastating intraocular infection which should not be missed. Often cases present to the accident and emergency department. Accurate and prompt assessment is key in saving sight and life. We present one such case and how it was surgically managed.

Unfolding the diagnosis of subspectacular fluid opacity in a corn snake (Pantherophis guttatus).

OBJECTIVE: To present the results of clinical, surgical, and histopathologic procedures and how these were compared with the initial presumptive clinical diagnosis in a corn snake (Pantherophis guttatus) presenting with subspectacular fluid opacity; and to improve upon currently established surgical enucleation techniques in the snake. ANIMAL STUDIED: An 8-month-old corn snake was presented for enlarged globe OD. PROCEDURES: The following diagnostics were performed: systemic and ophthalmic examinations, complete blood count, cytology and culture of subspectacular fluid, and histopathology of enucleated globe and spectacle. Enucleation was performed in a routine fashion with the addition of a porcine small intestinal submucosa bioscaffold graft (SISplus™; Avalon Medical, Stillwater, MN), sutured over the orbit. RESULTS: Systemic examination revealed signs of maxillary stomatitis. Ophthalmic examination revealed semitransparent fluid in the subspectacular space. Complete blood count was unremarkable. Cytology of fluid obtained via subspectacular centesis was acellular, and culture grew Clostridium perfringens, which was consistent with the clinical suspicion of right maxillary stomatitis. Histopathology of the enucleated globe revealed spectaculitis, characterized by regional heterophilic inflammation, and no evidence of lymph dissection in the (peri)ocular tissues. The final diagnosis was a subspectacular abscess. Follow-up revealed that the SIS graft provided excellent healing and cosmesis of the surgical site. CONCLUSIONS: While there are reports of lymphatic fluid dissection between skin layers during ecdysis, which can result in an opaque spectacle, the fluid opacity in this case was attributed to a subspectacular abscess secondary to an ascending oral infection. Addition of biological wound dressing may contribute to positive post-enucleation outcome in the snake.

Leptospiral antibody prevalence and surgical treatment outcome in horses with Equine Recurrent Uveitis (ERU) in Switzerland.

OBJECTIVE: To evaluate leptospiral antibody prevalence in 65 horses with ERU and compare outcome in 36 surgically treated eyes (2010-2015). PROCEDURES: Retrospective data analysis of horses with ERU (n = 65). C-value calculation with microagglutination assay titer (MAT) results for Leptospira spp. Evaluation of follow-up data after pars plana vitrectomy (PPV, n = 21 eyes) and suprachoroidal cyclosporine device implantation (SCDI, n = 15 eyes). Differences between groups were statistically analyzed using Fishers exact test, significance set at P < .05. RESULTS: Positive leptospiral titers were found in 28/65 blood, 31/65 aqueous humor (AH), and 19/20 vitreal (post-PPV) samples. The most common intraocular serovars were Leptospira interrogans grippotyphosa, pomona, and bratislava. Intraocular antibody production was suspected in samples of 22 horses (c-values > 1). Mean follow-up of surgical cases was 3.8 years (PPV) and 3.4 years (SCDI). PPV was performed in 21 eyes with positive, SCDI in 15 eyes with negative leptospiral test results. Uveitis recurred less often after PPV (2/21) compared to SCDI (6/15, P = .04). Retinal detachment occurred after PPV only (5/21, SCDI 0/15, P = .06), whereas only SCDI-treated eyes were enucleated (PPV 0/21, SCDI 3/15, P = .06). Blindness or visual impairment was equally likely to occur in both treatment groups after surgery (PPV 7/21, SCDI 7/15, P = .5). CONCLUSIONS: Leptospiral antibody prevalence is high in horses with ERU in Switzerland. Recurrence of uveitis is uncommon following PPV in the present study; an increased risk of retinal detachment exists. Enucleation is more often warranted in horses after SCDI in this study due to a higher uveitis recurrence.

Eckardt keratoprosthesis for combined pars plana vitrectomy and therapeutic keratoplasty in a patient with endophthalmitis and suppurative keratitis.

This is a case report on the use of Eckardt keratoprosthesis for pars plana vitrectomy in a patient with endophthalmitis and suppurative keratitis that developed after cataract surgery. A 79-year-old woman developed acute-onset infectious endophthalmitis and suppurative keratitis after cataract surgery that failed to respond to treatment with antibiotic eyedrops and intravitreal antibiotic injection. Using a temporary keratoprosthesis that enabled sufficient visualization, vitrectomy was performed, followed by therapeutic keratoplasty using a cryopreserved donor cornea. The patient's vision was improved from light perception to counting fingers at 30 cm, 3 months postoperatively. There was no recurrence of infection or other significant complications.

Punctal dilatation and non-incisional canalicular curettage in the management of infectious canaliculitis.

OBJECTIVE: To describe the outcomes of punctal dilatation and non-incisional canalicular curettage in patients with infectious canaliculitis. METHODS: A retrospective analysis of 53 canaliculi of 47 eyes of 46 consecutive patients diagnosed with canaliculitis was performed from November 2015 to December 2018. All patients were treated with punctal dilatation and a non-incisional canalicular curettage. Parameters studied include demographics, clinical presentation, microbiological analysis, management and treatment outcomes. The outcome measures were clinical resolution of canaliculitis and resolution of epiphora. RESULTS: The mean age at presentation was 59.34 years with female preponderance (M:F = 19:28). Left eye was more affected (64%, n = 30) as compared to the right (36%, n = 17). Only one patient presented bilaterally. Lower canaliculus was most commonly involved (68%, n = 32). Six eyes showed involvement of both upper and lower canaliculus. Presenting symptoms include discharge (81%), swelling of the eyelids (64%), watering (55%), redness (51%) and pain (39%). Punctal dilatation and non-incisional canalicular curettage were performed using punctum dilator and a small chalazion scoop (1 mm Meyhoefer chalazion curette). Of the 53 involved canaliculi, 14 canaliculi of 14 eyes underwent a repeat curettage for complete resolution and 1 canaliculus underwent the same procedure thrice. The most common micro-organisms isolated were Streptococci species (28% cases). At a mean follow-up of 6.8 months, resolution of canaliculitis was achieved in all patients; however, epiphora persisted in two eyes (4%). CONCLUSION: Non-incisional canalicular curettage is a minimally invasive technique with good preservation of the punctal and canalicular anatomy. It also facilitates good anatomical and functional outcomes in infectious canaliculitis.

Prognostic Factors Affecting Graft Survival in Patients Undergoing Penetrating Keratoplasty for Infectious Keratitis.

Objectives: To evaluate the prognostic factors affecting graft survival in patients undergoing penetrating keratoplasty (PKP) for infectious keratitis. Materials and Methods: Patients who underwent PKP for keratitis in our hospital between 2013 and 2018 were retrospectively reviewed. Patients who underwent therapeutic PKP at the inflammatory stage and were followed for at least 12 months were included in the study. Age, gender, follow-up period, time between diagnosis and surgery, lens status, presence of limbal involvement, presence of corneal ulceration, perforation, or corneal abscess, type of microorganism detected in culture, number of fortified medications used before surgery and duration of use, preoperative and postoperative visual acuity, postoperative graft transparency, postoperative complications, recurrence of infection, rate of re-keratoplasty, and indication for and timing of re-keratoplasty were recorded. The relationship between these findings and anatomic, therapeutic, and functional success were evaluated. Results: Fifty-nine patients were included in the study; 40 (67.8%) were male and 19 (32.2%) were female, and the mean age was 59.78±19.46 (6-91) years. Anatomic success was achieved in 58 patients (98.3%). Therapeutic success was achieved in 47 patients (79.7%) and there was a significant relationship between therapeutic success and re-keratoplasty and early re-keratoplasty (p<0.001 for both). Thirty-two patients (54.2%) had functional success and there was a significant relationship between the absence of postoperative complications and functional success (p=0.014). Conclusion: PKP is an effective treatment option in treatment-resistant keratitis or keratitis with impending perforation. The absence of postoperative complications and performing early re-keratoplasty in patients with recurrence increase the success rate.

Femtosecond Laser-Assisted Penetrating Keratoplasty for Treating Infective Keratitis.

PURPOSE: To report the results of penetrating keratoplasty (PKP) assisted by femtosecond laser in the treatment of persistent infective keratitis. METHODS: Seven eyes of 7 patients with diagnosed infective keratitis were recruited. They showed no improvement on maximal medical therapy for a week. The causative organisms were Pseudomonas aeruginosa in 3 cases and Fusarium in 4 cases. All cases underwent femtosecond laser-assisted PKP with a mushroom-shaped cut. Postoperative antimicrobial medications were continued for 8-12 weeks. Sutures were removed after 6 months. Therapeutic success was defined as eradication of primary infection. Functional success was considered when visual function improves to 20/200 or better. RESULTS: All 7 eyes underwent femtosecond laser-assisted PKP. There were no intraoperative complications, and all patients had uneventful recipient cornea separation. Anatomic, therapeutic, and functional success was achieved in all patients. During the 6-month follow-up period, no recurrence of infection was reported. The average preoperative corrected distance visual acuity (CDVA) was 2.07 log of the minimal angle of resolution (LogMAR) ± 0.21, whereas at 6 months postoperatively, the average CDVA was 0.17 LogMAR ± 0.13, with a P value of 0.00025. CONCLUSIONS: Femtosecond laser-assisted PKP was found to be an effective method for treating infective keratitis (particularly that caused by Pseudomonas aeruginosa and Fusarium) that did not respond to medical treatment. Early surgical intervention before the disease becomes advanced is recommended.

Can cryotherapy be used as an adjunct in select cases of recalcitrant endophthalmitis? - A case report.

We report two cases of recalcitrant endophthalmitis, a delayed postoperative fungal endophthalmitis following cataract surgery and an atypical mycobacterial endogenous endophthalmitis associated with infective scleritis. Due to recalcitrant nature of the endophthalmitis, one or more sittings of double freeze and thaw cryotherapy was applied over and adjacent to the infective foci in each case. This cryotherapy was used as an adjunct alongside conventional endophthalmitis management following which resolution of infection was observed in both cases.

Clinical presentations and comparative outcomes of primary versus deferred intraocular lens explantation in delayed-onset endophthalmitis.

Purpose: To describe clinical presentations and comparative outcomes of primary versus deferred intraocular lens (IOL) explantation in delayed-onset endophthalmitis. Methods: In this retrospective study, a total of 77 eyes of 77 patients that were diagnosed clinically as delayed-onset endophthalmitis and underwent IOL explantation from January 1990 to January 2018 were included undiluted vitreous biopsy and IOL were subjected to microbiologic evaluation. Duration of symptoms, presenting visual acuity, organisms isolated, time to IOL explantation, time to endophthalmitis, resolution after explantation, number of repeat intravitreal injections, and final visual acuity were compared in the primary and the deferred IOL explantation groups. Results: There were primary and deferred IOL explantations. Interval between inciting event and endophthalmitis, between onset of symptoms to presentation, total follow-up, complication rate, and final visual acuity was comparable between the two groups. Median time to IOL explantation in the deferred group was 70 days. Between the primary and deferred IOL explantation groups the number of repeat intravitreal injections was 0.58 ± 0.86 and 2.62 ± 1.78 respectively, (P < 0.0001, 95% confidence interval, CI 2.00-2.22); the number of days to resolution after IOL explantation was 35.16 ± 14.26 and 55.5 ± 8.24 respectively, (P < 0.0001, 95% CI 15.22-25.45). Conclusion: Early IOL explantation in delayed-onset endophthalmitis causes faster clinical resolution and reduces the number of repeat intravitreal injections. Final visual improvement, however, may be unaffected.