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. 2022 Mar 7;8(1):18.
doi: 10.1186/s40942-022-00370-8.

Decisive role of histopathology of lens capsule in the diagnosis of chronic fungal postoperative endophthalmitis

Mathias Paulo Loredo E Silva  1 , Rodrigo Magno da Silva Oliveira  1 , Bruno Freitas Lage  1 , Clóvis Arcoverde Freitas  1 , Moisés Salgado Pedrosa  2 , Márcio Bittar Nehemy  1   3 , Daniel Vítor Vasconcelos-Santos  4   5
Affiliations

Decisive role of histopathology of lens capsule in the diagnosis of chronic fungal postoperative endophthalmitis

Mathias Paulo Loredo E Silva et al. Int J Retina Vitreous. .

Abstract

We report three cases of refractory chronic endophthalmitis after cataract surgery presenting to a referral center, and with repeated negative cultures. Initial treatment consisted of intravitreal and systemic antibiotics, with partial improvement. After subsequent worsening, pars plana vitrectomy, intraocular lens explantation and en bloc capsulectomy were performed. Histopathological examination revealed multiple filamentous fungal structures, sequestered between anterior/posterior lens capsule in all cases. Chronic postoperative fungal endophthalmitis may manifest with negative cultures possibly associated with sequestration of the microorganism into the capsular bag. Careful histopathological examination of lens capsule in these cases may be essential for a definite diagnosis.

Keywords: Cataract surgery; Chronic endophthalmitis; Fungi; Intraocular inflammation; Intraocular lens; Uveitis.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Aspect of the anterior segment of the three patients. A Case 1: a hypopyon is seen in the left eye, with retroillumination delineating an inflammatory plaque at the inferotemporal aspect of the posterior lens capsule (asterisk). B Case 2: 4 + inflammatory cells in the anterior chamber and a hypopyon are seen. C Case 3: Infiltration is observed in superior aspect of the anterior capsule, with exudation to the anterior vitreous
Fig. 2
Fig. 2
Histopathological examination of the lens capsule of the three patients. Case 1: A Low magnification (PAS [Periodic acid Schiff] staining) shows areas of fibrosis of anterior and posterior lens capsule (black arsterisks), as well as localized inflammatory infiltration with formation of microabscess (red arrows). B, C On Grocott methenamine silver staining, multiple fungal structures are seen sequestered between the anterior and posterior lens capsule on higher magnification. Case 2: D Low magnification image (hematoxylin–eosin [HE] staining) displays dense inflammatory cell infiltration (red arrows), intermingled with foci of fibrosis (black asterisks). E, F PAS E and Grocott F staining reveal numerous septate fungal hyphae within the capsular bag, sequestered between anterior and posterior lens capsule. Case 3: G Low magnification (HE staining) shows focus of inflammatory infiltration (red arrow) and area of fibrosis (black asterisk). H On high magnification, a round PAS positive structure consistent with fungal element is disclosed (green arrowhead); vitreal culture eventually grew Acremonium sp
See this image and copyright information in PMC

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