Chronic low-grade endophthalmitis: A growing indication for intraocular lens removal

The aim of this study was to evaluate the effect of progress made in cataract surgery regarding the indications and results of intraocular lens (IOL) removal. For this purpose, the charts of all patients who had undergone IOL explantation at our institution between January 1990 and December 1992 were reviewed. Indications were divided into six groups: (a) chronic low-grade endophthalmitis; (b) pseudophakic bullous keratopathy; (c) luxation; (d) traumatic expulsion; (e) high-degree aniseikonia; (f) acute endophthalmitis. Visual acuities were grouped according to a good (1.0 to 0.5) acceptable (0.4 to 0.05) and poor (less than 0.05) outcome. Fifty-two IOL were removed from 52 eyes of 52 patients during the period considered in this study. Sixteen were anterior chamber, 5 were iris-fixated, and 31 were posterior chamber lenses. The removal rates were 30.8% for chronic, low-grade endophthalmitis (n = 16), 28.8% for bullous keratopathy (n = 15), 28.8% for luxation (n = 15), 5.8% for traumatic expulsion (n = 3), 3.8% for high-degree aniseikonia (n = 2), and 1.9% for acute endophthalmitis (n = 1) After explantation vision equal to or better than 20/400 was achieved by the vast majority of patients in all groups with the exception of those with bullous keratopathy. The progress made in cataract surgery over the last decade has greatly influenced the rate of complications leading to IOL removal. Continuous monitoring of explanted IOLs is mandatory to evaluate further changes in surgical technique and lens design.