J Korean Ophthalmol Soc.  2019 May;60(5):480-485. 10.3341/jkos.2019.60.5.480.

Endophthalmitis after Removal of an Intralenticular Foreign Body in Place without Symptoms for 20 Years

• Choi Y
• Eom Y
• Choi SY
• Lee BY
• Kim EJ
• Kang SY
• Song JS
• Kim HM

• KMID: 2445143
• DOI: http://doi.org/10.3341/jkos.2019.60.5.480

Abstract

PURPOSE
We report a case of postoperative endophthalmitis in the cataract patient, associated with removal of an intralenticular foreign body that had remained in place without symptoms for 20 years.
CASE SUMMARY
A 45-year-old male visited our outpatient clinic complaining of gradual visual loss in his right eye over the past 3 months. In slit-lamp examinations, anterior capsular opacification, nuclear sclerosis, and posterior subcapsular opacity were observed in the right eye. Twenty years before, a tiny metallic projectile had hit his right eye, but slit-lamp examination at the time of injury did not reveal any intraocular foreign body. We decided to undergo cataract surgery. During phacoemulsification, a metallic foreign body was found in the lens and safely removed; then an intraocular lens was implanted. As hypopyon was evident 3 days later, we injected intravitreal antibiotics and applied fortified antibiotic eye drops to the right eye. The anterior chamber inflammation improved and the best-corrected visual acuity recovered to 1.0.
CONCLUSIONS
Surgeon should be aware of that endophthalmitis could develop after cataract surgery with removal of an intralenticular foreign body that had been in place for 20 years. But did not trigger inflammation or cause any symptoms as the cataract progressed.

Keyword

Cataract surgery; Endophthalmitis; Intralenticular foreign body

MeSH Terms

Ambulatory Care Facilities
Anterior Chamber
Anti-Bacterial Agents
Cataract
Endophthalmitis*
Foreign Bodies*
Humans
Inflammation
Lenses, Intraocular
Male
Middle Aged
Ophthalmic Solutions
Phacoemulsification
Sclerosis
Visual Acuity
Anti-Bacterial Agents
Ophthalmic Solutions

Figure

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  Figure 1 Anterior segment photographs of the patients at the first visit. Anterior capsular opacification and nuclear sclerosis were found in the right eye (A) and a small corneal opacity was observed in the center of the right cornea, which was considered to be a sign of previous penetration (B).

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  Figure 2 Intraoperative photographs. An intralenticular metallic foreign body found during phacoemulsification (red arrow) (A) and the posterior capsule was intact (B).

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  Figure 3 Removal of an intralenticular metallic foreign body. A balanced salt solution was injected into the back of the metallic foreign body to safely remove it (red arrows) with pressure gradient through the clear corneal incision (A–F).

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  Figure 4 Anterior segment photographs three days after cataract surgery. Conjunctival hyperemia, hypopyon (A), and anterior chamber exudative reactions (B) are observed.

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