J Korean Ophthalmol Soc.  2013 Dec;54(12):1939-1944.

A Case of Acute Endophthalmitis Following a Dexamethasone Intravitreal Implant

• Han HC
• Bang JW
• Yum JH
• Kim JH
• Lee DH
• Lee JH

Abstract

PURPOSE
To report a case of acute endophthalmitis after a dexamethasone (Ozurdex(R)) intravitreal implant for macular edema (ME) secondary to branch retinal vein occlusion (BRVO).
CASE SUMMARY
A 63-year-old male patient presented with decreased vision in the right eye due to ME secondary to BRVO. The patient was treated with an intravitreal bevacizumab injection, but ME did not improve. Two months after the injection, dexamethasone (Ozurdex(R)) intravitreal implantation was performed. Four days after the implantation, the patient visited our clinic complaining of severe visual disturbance. Slight conjunctival injection was observed and inflammatory cells and hypopyon were found in the anterior chamber. Fundus was not visible due to vitreous opacity. The patient was presumed to have acute endophthalmitis. Vitrectomy, intravitreal antibiotics injection, dexamethasone implant removal and phacoemulsification were performed. After treatment, the patient's fundus markedly improved, the inflammatory response was controlled and coagulase negative staphylococcus was detected from vitreous culture.
CONCLUSIONS
In cases of intravitreal dexamethasone implant associated with acute endophthalmitis, careful examination for diagnosis of endophthalmitis is recommended because the patient may not present with severe ocular pain and injection due to anti-inflammatory effect of corticosteroid.

Keyword

Branch retinal vein occlusion; Dexamethasone implant; Endophthalmitis; Intravitreal injection; Macular edema

MeSH Terms

Anterior Chamber
Anti-Bacterial Agents
Coagulase
Dexamethasone*
Diagnosis
Endophthalmitis*
Humans
Intravitreal Injections
Macular Edema
Male
Middle Aged
Phacoemulsification
Retinal Vein Occlusion
Staphylococcus
Vitrectomy
Bevacizumab
Anti-Bacterial Agents
Coagulase
Dexamethasone

Figure

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  Figure 1. Initial fundus photograph. The right eye shows branch retinal vein occlusion (BRVO) with macular edema.

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  Figure 2. The baseline optical coherence tomography (OCT) of the right eye shows macular edema (A). Despite intravitreal bevacizumab injection, macular edema did not improve at one month after injection (B).

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  Figure 3. Slit lamp photograph of the right eye shows hypopyon in the anterior chamber (A). Ultrasonogram of the right eye shows vitreous opacity (B).

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  Figure 4. Fundus appearance during vitrectomy. Vitreous fibrosis and opacity was removed through previous vitrectomy (A). The implant was easily removed by the vitreotome tip (B).

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  Figure 5. Fundus photograph (A) and optical coherence tomography (B) of the right eye, one month after treatment shows the macular edema much improved.

Reference

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