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In two children, pyogenic endophthalmitis developed simultaneously with Haemophilus influenzae type b meningitis. The eye of one of the patients recovered fully; the eye of the other became phthisical and was enucleated. Culturable or pathologically identifiable organisms were not found in either eye; nevertheless, it is suggested that these cases represented metastatic H influenzae type b endophthalmitis from a primary site of infection in the meninges.

Subtotal pars plana vitrectomy was performed in four patients with chronic toxocaral endophthalmitis. In two instances, chronic intraocular inflammation proved unresponsive to intensive corticosteroid therapy, but improved dramatically following vitrectomy. In one patient, a dense retrolenticular membrane was removed, and intractable amblyopia was prevented. Vitrectomy relieved vitreoretinal traction involving the macula in two instances and cured a peripheral traction retinal detachment in a third. Information gleaned from these cases suggests new guidelines for the laboratory confirmation of ocular toxocariasis. Patients with toxocaral endophthalmitis may benefit from pars plana vitrectomy when chronic inflammation does not respond to medical measures or when such inflammation causes permanent structural changes that threaten or interfere with central vision.

We used delayed primary wound closure in three cases of bacterial endophthalmitis to minimize the risk of implant extrusion following evisceration. In a fourth case, the wound was closed primarily, but wound dehiscence and implant extrusion occurred six weeks postoperatively, and reoperation was required. The advantages of delayed primary wound closure following evisceration of the globe for endophthalmitis include rapid removal of the intraocular abscess, continued drainage and mechanical débridement of the infected scleral pouch, and the development of granulation tissue resistant to bacterial growth at the wound margins prior to wound closure. These factors are important in reducing the risk of implant extrusion following evisceration of the globe for endophthalmitis.

We successfully treated six patients with culture-proven acute bacterial endophthalmitis by a combination of emergency pars plana vitrectomy and the instillation of intravitreal antibiotics. All six patients regained satisfactory vision.

Two series of patients with endophthalmitis were compared. In the group treated with antibiotics or fungistatics, only 1 eye (4.3%) could be salvaged, whereas in the group with pars plana vitrectomy and antibiotics or fungistatics, 7 eyes (33%) had adequate visual acuity afterwards.

A general review of the treatment of Candida endophthalmitis is undertaken, with particular emphasis on the efficacy of various drugs currently in use. Their absorption by the eye when given systemically is also considered. The limitations of medical treatment for this condition are discussed and the theoretical reasons for vitrectomy considered. Six cases that underwent vitrectomy are reviewed, and the indications for vitrectomy in Candida endophthalmitis are discussed. A tentative overall plan for the management of such cases is given.

A 49-year-old man developed Aspergillus endophthalmitis after a perforating corneal injury. The infection was successfully treated with antifungal therapy and surgery.

We treated 16 patients (16 eyes) with culture-proven exogenous bacterial endophthalmitis with intravitreal and subconjunctival antibiotics but without systemic antibiotics. After one to two sets of intravitreal injections, intraocular inflammation abated in all patients. After further surgery in four patients, all 16 eyes had clear media and attached retinas. Fifteen eyes attained a visual acuity of 20/400 or better; 12 eyes achieved 20/80 or better.

A previously healthy 70-year-old white man sustained a plant injury to his left eye while gardening and was admitted here because of an ensuing perforated cornea and endophthalmitis. The lens was opaque and its anterior capsule was ruptured. Culture of fluid obtained by anterior chamber paracentesis yielded a species of the Erwinia herbicolalathyri group (Enterobacter agglomerans). Thirty-seven days after a course of cefazolin and gentamicin therapy, corneal edema necessitated a planned extracapsular cataract extraction. The aqueous humor and lens again revealed the identical Erwinia species in pure culture. The patient received another course of cefazolin and showed improvement after the lens aspiration.

Anterior staphylomas developed in two young patients as a postoperative complication of hyphema extractions through corneoscleral sections. The patients, aged five and nine years, underwent evacuation of the hyphemas after rebleeding caused medically unmanageable intraocular pressure elevations. Postoperatively, both patients received corticosteroids and had elevation of intraocular pressure. To repair the staphyloma, a scleral overlay patch graft was performed in one patient, but the intraocular pressure remained elevated and the staphyloma gradually recurred. Enucleation of the eye was eventually required. Resection of the staphylomatous area with lensectomy and complete vitrectomy was performed in the second patient. After four years of follow-up this patient continues to do well.

Two cases of pseudophakic phacoanaphylactic endophthalmitis are reported. Both responded favorably to a total posterior capsulectomy performed in addition to removal of the intraocular lens and remaining cortical material. Current theories on phacoanaphylactic endophthalmitis are discussed. Excision of the entire posterior capsule with anterior capsular flaps and entrapped cortex is emphasized as an integral part of the treatment of this condition.

A 75-year-old woman was treated successfully for endophthalmitis due to a coryneform bacterium contracted from a contaminated corneal graft. We were able to study the involved eye histologically when the patient died unexpectedly 5 1/2 weeks after treatment. The vitreous contained a moderate number of macrophages filled with PAS-positive particles. Ultrastructurally, the PAS-positive particles corresponded to degenerating bacterial cell walls. The striking resemblance of the macrophages in this case to macrophages in Whipple's disease is intriguing because Corynebacterium has been the most frequently implicated bacterial genus in the pathogenesis of Whipple's disease.

Sixteen cases of previously reported culture-proven Propionibacterium-associated endophthalmitis after extracapsular cataract extraction (ECCE) are reviewed. The inflammation was observed 2 to 10 months after surgery and occurred after laser posterior capsulotomy in four cases. Clinically, it appeared as a chronic iridocyclitis characterized by granulomatous-appearing keratic precipitates (5 cases), hypopyon (10 cases), and a white plaque on the posterior capsule or intraocular lens (IOL) implant (8 cases). Response to corticosteroid treatment was transient. Surgical intervention was required between 1 and 16 months after the inflammation began and included removal of the IOL and capsular bag via the limbus in 7 cases and pars plana vitrectomy in 11. Intravitreal antibiotics were administered in 12 cases. Postoperative visual acuity ranged from 20/20 to count fingers, with 11 of 16 patients recovering visual acuity of 20/40 or better. Propionibacterium-associated endophthalmitis should be suspected if chronic indolent intraocular inflammation develops after ECCE. Intraocular specimens should be obtained and submitted for aerobic and anaerobic culture and cytologic/histopathologic studies. Based on the clinical courses of these patients, recommendations for management are discussed.

We describe an infrequent case of endophthalmitis due to intraocular caterpillar hairs. We report a notable decrease of inflammation after Argon laser photocoagulation of the caterpillar hairs. We also present optical and electronic microscope photographs of one of the hairs extracted from the patient's conjunctiva.