Anterior chamber drainage with a silicone tube as an adjunctive treatment for refractory endophthalmitis

Objective: To describe a novel surgical approach using a silicone tube device for anterior chamber drainage as an adjunctive treatment in patients with refractory endophthalmitis.Methods: We conducted a retrospective, single-center, non-randomized case series including patients with endophthalmitis of different etiologies, managed at the Maldonado Bas Eye Clinic between 2012 and 2021. All patients had received conventional treatment for endophthalmitis (topical fortified antibiotics, systemic therapy, anterior chamber lavage, vitrectomy, conjunctival flap, or keratoplasty) without satisfactory response. The technique involved the implantation of a silicone tube connecting the anterior chamber to the suprascleral space, covered by a scleral or corneoscleral patch and conjunctiva. Outcomes were assessed through infection control, best-corrected visual acuity (BCVA), and follow-up examinations at 12 months.Results: Six patients were included. All presented with corneal abscess and signs of endophthalmitis at baseline. Five of the six patients (83%) achieved infection control after tube implantation, with no need for continued antibiotic therapy or further evidence of infection during follow-up. Visual outcomes varied according to baseline vision and severity, with final BCVA ranging from light perception to 20/25. One patient required evisceration due to uncontrolled infection.Conclusion: Anterior chamber drainage with a silicone tube device proved to be a safe and potentially effective adjunctive technique for refractory endophthalmitis, achieving infection control in most cases. This approach should be considered as a complementary therapeutic tool within the current armamentarium against endophthalmitis, particularly in extreme scenarios where conventional management has failed. Further studies are needed to validate these findings.