J Korean Ophthalmol Soc.  2016 Sep;57(9):1480-1483. 10.3341/jkos.2016.57.9.1480.

A Case of Phacoanaphylactic Uveitis Presenting as Endophthalmitis

• Kim JH
• Yoo WS
• Kong MG
• Han YS
• Chung IY
• Seo SW
• Yoo JM
• Kim SJ

• KMID: 2351882
• DOI: http://doi.org/10.3341/jkos.2016.57.9.1480

Abstract

PURPOSE
To report a case of phacoanaphylactic uveitis presenting as endophthalmitis.
CASE SUMMARY
A 77-year-old woman presented with sudden visual disturbance and painful red right eye. She did not have a history of trauma or surgery in her right eye. Her best corrected visual acuity was hand movement in the right eye and log MAR 0.22 in the left eye; intraocular pressure was 27 mm Hg in the right eye and 15 mm Hg in the left eye. Slit-lamp examination revealed corneal edema and prominent inflammation with hypopyon in the anterior chamber. B-scan showed vitreous opacity behind the lens. Based on the diagnosis of endophthalmitis, anterior chamber paracentesis and irrigation were performed. After irrigation, a hypermature cataract with intact anterior capsule was observed. Therefore, we performed extracapsular cataract extraction and intravitreal antibiotics injection. Gram staining of the aqueous humor revealed numerous macrophages filled with lens protein but no organisms. She was treated with hourly topical corticosteroid and an antibiotic agent. One month later, the anterior chamber is clear, and the cultures remained negative.
CONCLUSIONS
We report a case of spontaneous phacoanaphylactic uveitis presenting as endophthalmitis in a patient with no history of eye trauma or surgery.

Keyword

Anterior chamber paracentesis; Endophthalmitis; Macrophages; Phacoanaphylactic uveitis

MeSH Terms

Aged
Anterior Chamber
Anti-Bacterial Agents
Aqueous Humor
Cataract
Cataract Extraction
Corneal Edema
Diagnosis
Endophthalmitis*
Female
Hand
Humans
Inflammation
Intraocular Pressure
Macrophages
Paracentesis
Uveitis*
Visual Acuity
Anti-Bacterial Agents

Figure

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  Figure 1. Anterior segment photograph and ultrasonograph. (A, B) At initial presentation first visit, slit-lamp examination revealed marked corneal edema, and severe anterior chamber inflammation with hypopyon in the right eye. (C) B-scan revealed a scanty vitreous opacity in the posterior the lens.

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  Figure 2. Light microscope examination of aqueous humor revealed the presence of macrophage with intracystoplasmic lens material (magnification ×1,000: Papanicolaou staining).

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  Figure 3. Anterior segment photograph and Fundus photograph. 1 month later Anterior segment photograph (A) and fundus photograph (B) reveals no cellular inflammatory reaction in the anterior chamber and macular degeneration in the fundus.

Reference

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