Infectious Endophthalmitis May Develop Late After Scleral Fixation

Doctor performing eye surgery in modern clinic
Infectious endophthalmitis developed approximately 23 months after scleral fixation, a study shows.

Infectious endophthalmitis may develop late after scleral fixation of an intraocular lens (IOL), is typically associated with exposed sutures, and yields poor visual outcomes, according to a case series published in Retina.

Investigators in South Korea sought to determine the mechanism of infection, clinical features, and risk factors of endophthalmitis after IOL scleral fixation. The study included 15 patients with infectious endophthalmitis after scleral fixation of an IOL between April 2004 and December 2017, and 4 patients found via literature search (9 men, 9 women, 1 patient’s sex was unknown). The mean age of endophthalmitis onset was 57.1 ± 20.1 years (range: 4-82 years).

Investigators found that infectious endophthalmitis developed at a mean of 23 months (range: 1 day–10 years) after scleral fixation. Overall, 9 eyes (47.4%) had early-onset endophthalmitis (<6 weeks), and 10 eyes (52.6%) had delayed-onset endophthalmitis (>6 weeks). Presumed microbial influx due to suture exposure occurred in 11 eyes (57.9%). 

Patients 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 patients with early-onset endophthalmitis. 

Despite aggressive treatment, the team reported that visual outcomes were poor. They also found that 1 patient still had endophthalmitis due to suture exposure 10 years after IOL scleral fixation. 

According to the research, “When exposed sutures are present, cauterization, cutting, burying under the conjunctival and Tenon cysts, or grafting the sclera to cover the exposed area may help prevent infectious endophthalmitis.”

Limitations of the study include the retrospective design, small sample size, and possibility of selection bias. Further, the incidence rate of endophthalmitis cannot be ascertained because researchers could not obtain the total amount of patients who underwent scleral fixation surgery.

“It is necessary to inform patients about the possibility of postoperative suture exposure and infectious endophthalmitis even years after surgery and to check the condition of the suture regularly,” the study says. “Preventive measures should be performed if an exposed suture is found.”


Kim KW, Park UC, Ahn J, et al. Infectious endophthalmitis after scleral fixation of an intraocular lens. Retina. 2021;41(1):2310-2317. doi:10.1097/IAE.0000000000003176