Purpose: To investigate whether endophthalmitis is more common after secondary intraocular lens (IOL) implantation than after other intraocular surgeries. Risk factors, causative organisms, and visual acuity outcomes of endophthalmitis after secondary IOL implantation were investigated. Methods: The ten cases consisted of all patients treated at the Bascom Palmer Eye Institute between January 1, 1984, and December 31, 1994, for endophthalmitis after secondary IOL implantation. The 34 control patients consisted of all patients who underwent secondary IOL implantation within 3 years of the case patients (6-year span) by the same surgeons but who did not develop endophthalmitis. Demographic and clinical data were abstracted from patients' medical records. Results: Fifty percent (5 of 10) of case patients had a history of diabetes mellitus, compared with 5.9% (2 of 34) of control patients. All three posterior chamber IOLs among case patients had transscleral suture fixation, whereas all four posterior chamber IOLs among control patients were in the sulcus without scleral sutures. Case patients were more likely than control patients to have IOLs with polypropylene haptics (30.0% and 5.9%, respectively) and to have had their IOLs placed through a superior rather than a temporal incision (70.0% and 17.9%, respectively). Eighty percent of case patients and 14.7% of control patients had either eyelid abnormalities (marked blepharitis, ectropion) or postoperative wound defects. Staphylococcus epidermidis was isolated in 50% of case patients. After treatment, 90.0% of case patients achieved a visual acuity of greater than or equal to 20/100. Conclusion: Endophthalmitis after secondary IOL implantation was associated with diabetes, transscleral suture fixation of posterior chamber IOLs, polypropylene haptics, preoperative eyelid abnormalities, re-entry of eye through a previous wound, and postoperative wound defects. Most cases were caused by Staphylococcus epidermidis, and the post-treatment visual outcomes were generally good.
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