1. After Cataract Surgery…
Rowayda M. Amin, MD
Assist. Lecturer of Ophthalmology
Ihab Osman, MD, Islam Shereen, MD
Lecturer of Ophthalmology, Islam
Alexandria University

2. Ocular History
57 year old female referred for chronic post-operative inflammation following uneventful cataract surgery 5 months before
Diminished vision, minimal pain and photophobia
No systemic disease
Hysterectomy 8 months prior

3. First Presentation OD VA: 4/60 2+ AC cell, mild flare OS Unremarkable
Pseudophakic

4. First Presentation - Right Fundus
Moderate haze
Severe vitritis
Optic disc hyperemia
VA: 4/60

5. First Presentation - Right Fundus
Whitish small flaky mass in the inferior vitreous
Snowball?
Retained lens
fragment?

6. First Presentation - Left Fundus
Normal disc
and vessels
VA: 6/6

7. Work-up CXR PPD Blood work Meticulous review of systems
All were negative
Working hypothesis: lens-induced uveitis

8. Treatment corticosteroids Oral Prednisolone 60 mg/day
2 weeks later…no improvement
periocular corticosteroids
subtenon Triamcinolone (40mg)
1 month later…no improvement
Vitrectomy against lens-induced-uveitis

9. 48 hours after Vitrectomy
Vitreous still hazy
2 whitish masses in the
vitreous cavity now
VA: 4/60

10. Reconsider Diagnosis
infection?
masquerade syndrome?
AC tap

11. Candida Endophthalmitis

12. Right Fundus
Whitish small flaky mass in the inferior vitreous seen 1.5 months prior was:
FUNGUS BALL

13. Treatment Options Systemic antifungals
Fluconazole ( mg po) daily for approximately 2 months.
Voriconazole
For moderate-to-severe inflammation
PPV with intravitreal amphotericin B

14. Treatment Patient already had vitrectomy Systemic Fluconazole 200mg/d
intravitreal Amphotericin B
begin: 1.5 months after first presentation

15. 12 hours later… Severe haze and AC hypopion No pain, mild injection
Endophthalmitis?
Sterile or infectious?
1/60

16. Endophthalmitis again?
Differentiating between sterile and infectious endophthalmitis can be difficult.
Sterile endophthalmitis typically has no pain, a quiet conjunctiva, occurs within 24 hours of surgery and is culture negative.
Infectious endophthalmitis is characterized by pain, later onset, vitritis, culture positive and has more prevalent lid swelling, chemosis, injection and discharge.

17. 72 hours later… 40 mg oral steroids hourly topical steroids
daily follow up
hypopion resolved
media clear

18. 4 weeks later…
VA improved to 6/24
resolved vitritis
no vitreous haze

19. Conclusion
Infectious endophthalmitis is an important cause of inflammation following intraocular surgery. However, not all cases are infectious .
Involvement of the posterior segment makes differentiating sterile from infectious endophthalmitis challenging.
Early recognition and prompt treatment are essential to reduce long-term sequelae.