Aims  To evaluate the efficacy of anterior chamber and lens capsular bag irrigation with antibiotics for initial treatment of acute low-grade endophthalmitis after clear corneal cataract surgery.
Methods  Retrospective, observational case series of six consecutive patients with acute postoperative endophthalmitis between January 2009 and June 2010.
RESULTS  Patients were treated with anterior chamber and lens capsular bag irrigation, with balance salt solution containing 0.04 mg/ml ceftazidime and 0.02 mg/ml vancomycin in topical anesthesia. Hypopyon and anterior chamber reactions were noted in all cases. The time from cataract surgery to presumed diagnosis of endophthalmitis was from 19-21 hours in all patients, and all of them were promptly treated within 4 hours after presumed diagnosis. After antibiotic irrigation, the inflammation subsided within 3-7 days. Visual acuity improved in all patients and remained stable during the follow-up period, which ranged from 3 to 18 months. No further interventions were required, and no recurrence was recorded. Neisseria mucosa was cultured in one aqueous sample (16.7%) and Sphingomonas paucimobilis in one conjunctival sample (16.7%).
CONCLUSIONS  The results suggest that early recognition and appropriate treatment result in a better outcome in patients with acute low-grade endophthalmitis after cataract surgery. As a first step, and a minimally invasive method, anterior chamber and lens capsular bag irrigation with antibiotics was effective for cases that were diagnosed early, in which the inflammation response was mostly restricted to the anterior chamber.