UNWANTED CATARACT SURGERY COMPLICATION (ACUTE ENDOPHTHALMITIS) -CASE REPORT

Endophthalmitis is a purulent inflammation of the eyeball and intraocular fluids (vitreous/aqueous humor) caused by an infective agent. Severe intraocular inflammation is the result of infection of the vitreous cavity, and progressive vitritis is the basic characteristic of every endophthalmitis form. There are exogenous (acute/chronic postoperative, traumatic, associated with blebitis, corneal ulcer, after intravitreal injections) and endogenous (bacterial/fungal chorioretinitis+/- vitritis). Acute postoperative is the most common and occurs early after surgery within 1-2 weeks, most often 3-5 days. Main signs: pain, loss of vision, discharge, hypopyon, vitritis, retinal periphlebitis, retinitis. Treatment: medicamentous(topical, systemic, vitreal antibiotics, antimycotics) and surgical (vitrectomy).

 Presentation of cataract surgery complication performed in small general hospital in first postoperative days, which was despite the applied therapy in regional referent center ended with loss of eye.

81year old male(ZC) referred to University Clinical Center from small town general hospital with pain, redness, abundant purulent discharge in right eye, which was operated four days before. He suffers from high blood pressure and diabetes.VA(OD)=light perception;VA(OS)=0.5;TOD=N+2(dig); TOS=15mmHg. Slit lamp:Blepharospasm, conjunctival chemosis, opaque cornea, annular stromal infiltrate, defect of the epithelium and superficial stroma in the lower third(FT+), at 12 o'clock clear corneal incision with incarcerated iris tissue, hypopyon in CA. BscanOD: Dense vitreal opacities, stratified, thickened bulbar wall(3.75mm), nasally shallow retina detachment. Dg:OD: Purulent endophthalmitis. Corneal ulcer. Glaucoma secundum. OS Cataracta senilis incipiens. Treatment: lavage of anterior chamber was performed (cefuroxime), the corneal wound was sutured, Vancomycin and Ceftazidime applied intravitreally. Systemic:Amp.Ceftriaxone 2g, Amp.Gentamycin 120mg/12h, Amp.Clindamycin/8h(NoX). Topical:Moxifloxacin, Tobramycin, Dorzolamide, Atropine, Chloramphenicol. Microbiological examination: Staphyloccocus alpha haemolyticus(corneal screiping), mycological negative. Lab: Le(7.3), Ne(69.50), CRP(67.7), SE(44),gly(10.5); after Th:Le(10,2), Ne(77,82), CRP(4,9), SE(18).

Due to the opaque cornea, it was not possible to perform vitrectomy. The defect of the epithelium and stroma expands, intensifies the infiltrate, and melted the cornea. BscanOD: dense opacificationCVa, high-reflectivity membrane corresponds to retinal detachment. Evisceration performed after patient consent. The patient was discharged in good general condition.

The presented devastating case of acute exogenous endophthalmitis after cataract surgery, associated with corneal ulcer and wound dehiscence  indicates the necessity of urgent and adequate therapy.