Risk Factors, Clinical Characteristics, Management, and Visual Prognosis of Traumatic Lenticular Abscess
Purpose
To analyze the distinct clinical features that differentiates post-traumatic lenticular abscess from traumatic cataract and evaluate risk factors, common pathogens, management and visual outcomes.
Methods
Retrospective analysis of 24 eyes of 24 patients clinically diagnosed with traumatic lenticular abscess during the period January 2012 to May 2014. History and details of slit-lamp examination were documented at the time of presentation. Visual acuity, ultrasonic B scan and retina status was noted. After controlling inflammation medically, lenticular abscesses were drained, extra-capsular cataract extractions were done. Secondary interventions like anterior and core vitrectomy, intracameral, intravitreal antibiotics and secondary IOL were done whenever necessary Microbiologic work-up of lens aspirates and vitreous humor were performed. Anatomical and visual outcomes were noted with mean follow-up time.
Results
The mean age was 37.63 years, with a male predominance of 80%. All patients had a history of penetrating injury with sharp objects. The mean time to presentation after injury was 13.33 days. A self sealed point entry of cornea, dense homogenous abscess beneath sealed anterior capsular dehiscence, often presented with hypopyon. The primary intervention included lens extraction with lens aspiration. 5 eyes underwent core vitrectomy. While abscess material grew 5 bacterial and one fungal isolates, vitreous culture remained negative. Mean follow-up was 6.75 months. 17 patients (80%) had best corrected visual acuity better than 6/18 at last follow-up.
Conclusion
Post-traumatic lenticular abscess is a distinct entity. Surgical removal of the abscess, intracameral antimicrobials and postoperative steroids were effective in cases of posttraumatic intralenticular abscess. Early diagnosis along with prompt surgical intervention and secondary IOL placement can be useful in restoration of vision.