A diagnostic dilemma in a patient with delayed onset endophthalmitis

Abstract

We report a case of nonpainful uveitis nine months after an uncomplicated phacoemulsification cataract surgery. Chronic postoperative endophthalmitis was suspected. Diagnostic vitrectomy and partial capsular bag removal was performed, but the specimens cultured in microbiology laboratory showed no pathogens. Systemic workup came positive for skin Tuberculosis test, and presumed intraocular tuberculosis treatment was started accordingly. Inflammation persisted, so a repeat vitrectomy was performed with removal of the lens implant with the capsule, and this time bedside culture inoculation was performed in operating room, revealing Pseudomonas infection. Delayed-onset postoperative endophthalmitis typically progresses slowly and therefore can be confused with uveitis and treated with steroid and immunosuppressant treatment regimes. Our case confirms both the value of immediate bacterial inoculation and the necessity of aggressive surgical treatment in chronic postoperative endophthalmitis cases.

Keywords: Endophthalmitis; Pseudomonas; Uveitis.

Fig. 1

(A) Anterior segment photograph of cornea, showing endothelial folds due to edema. (B) Keratic precipitates scattered in diffuse pattern. (C) Fundus photograph of grade 3 vitreous haze. (D) Hypopyon formation in the third week of initial vitrectomy. (E) Fundal appearance following the second vitrectomy and silicone oil tamponade.