To determine the mechanism of infection, clinical features, and risk factors of endophthalmitis after scleral fixation of an intraocular lens (IOL).
We included fifteen patients with infectious endophthalmitis after scleral fixation of an IOL between April 2004 and December 2017, as well as four patients found through a literature search. Thus, a total of nineteen patients were analyzed.
Among nineteen eyes, infectious endophthalmitis developed at a mean of 23 months (range: 1day–10 years) after scleral fixation surgery. Nine eyes (47.4%) had early-onset endophthalmitis (≤6 weeks), and ten eyes (52.6%) had delayed-onset endophthalmitis (>6 weeks). Eleven eyes (57.9%) had presumed microbial influx due to suture exposure. Those with delayed-onset endophthalmitis showed a higher rate of suture-related infection (80.0% vs. 33.3%) and culture of gram-negative bacteria (70.0% vs. 12.5%) than did those with early-onset endophthalmitis.
Infectious endophthalmitis can develop late after scleral fixation of an IOL, usually related to the exposed sutures, and the visual prognosis is poor. Eyes that have sutured scleral fixation should be monitored regularly, and preventive measures should be performed if an exposed suture is found.