The pathomechanism of acute exogenous endophthalmitis, subacute endogenous endophthalmitis (mycoses, sometimes protozoa and rarely bacteria) and chronic endogenous endophthalmitis demand different indications for vitrectomy.
Acute endophthalmitis demands, contrary to the subacute and chronic course of the disease, a prompt surgical intervention in form of vitrectomy with total iridectomy and if necessary lentectomy to get an optimum of aqueous humour ventilation after a general antibiotic application. Also intraocular antibiotic therapy during the operation is indispensable in these cases. Nevertheless, only three out of seven eyes with most severe intraocular inflammation showed a visual acuity of 20/100 to 20/20 after 7 to 18 months follow-up.
Subacute endophthalmitis in all our cases after candida mycosis, which did not come to a standstill in spite of antimycotic therapy, has been treated by a vitrectomy without intraocular antimycotic therapy, which may damage the intraocular tissue. Chronic endophthalmitis should be pre-treated with a cryoapplication as inflammatory signs often decrease under this treatment, furthermore the area around the pars plana and ora is ensured for later vitrectomy. The intervention should be performed before the visual acuity decreases down to 20/100 to prevent a complicating cataract and cystoid macula degeneration. In our cases of mycotic candida endophthalmitis and chronic endophtalmitis we observed beside one case an increase in visual acuity in all cases.
Measuring the immunoglobulines IgA, IgG and IgM from our vitreous material in chronic and for comparison also in acute endophthalmitis, the IgM-values were significantly higher in acute than in chronic inflammations. This result corresponds to the fact, that in the acute phase of the disease IgM-antibodies, and in the chronic phase IgG-antibodies are increasingly produced. We suppose that .no diffusion happens out of the serum into the vitreous body and only a local antibody production in the vitreous body takes place.