Department of Retina and Vitreous, Narayana Nethralaya #121/C, 1st R block, Rajaji Nagar, 560022, Bangalore, India.
BMC Ophthalmol. 2023 Nov 16;23(1):464. doi: 10.1186/s12886-023-03212-9.
Intraocular inflammation is common after anterior or posterior segment surgery. They typically manifest either as non-infectious inflammation of the anterior or posterior segment, known as toxic anterior or posterior segment syndrome (TPSS), or as sterile or infective endophthalmitis. In this report, we describe a rare case of TPSS following vitreoretinal surgery, presenting as hemorrhagic retinal vasculitis.
A 58-year-old male diagnosed with a left eye acute rhegmatogenous retinal detachment underwent an uneventful primary pars plana vitrectomy with silicone oil endotamponade on the same day of presentation. At presentation, there were no signs of intraocular inflammation, and his visual acuity in the affected eye was 20/200.
The retina was well-attached with silicone oil in place on the first post-operative day. Along the inferior retinal periphery, a hemorrhagic occlusive vasculitis was observed. Clinical examination revealed retained intraocular cotton fiber along the inferotemporal quadrant over the retinal surface. In addition to the standard post-operative medications, a course of systemic steroids (40 mg per day of Prednisolone tablets) was started. At the end of the first post-operative week, clinical signs of hemorrhagic retinal vasculitis were beginning to resolve, and by the end of the fourth post-operative week, they had completely resolved.
This report describes an unusual diagnosis of TPSS after vitreoretinal surgery, most likely due to the presence of an intraocular cotton fiber. This excessive inflammation of the posterior segment usually responds to a course of topical and systemic steroids.
眼内炎症在眼前段或眼后段手术后很常见。它们通常表现为前段或后段的非传染性炎症，分别称为毒性前段或后段综合征（TPSS）或无菌性或感染性眼内炎。在本报告中，我们描述了一例罕见的眼后段手术后 TPSS 病例，表现为出血性视网膜血管炎。
一名 58 岁男性，诊断为左眼急性孔源性视网膜脱离，当天行初次经睫状体平坦部玻璃体切除术联合硅油眼内填充术。就诊时，眼内无炎症迹象，患眼视力为 20/200。
术后第一天视网膜贴附良好，硅油在位。在下视网膜周边可见出血性闭塞性血管炎。临床检查显示视网膜表面颞下象限有残留的眼内棉纤维。除了标准的术后药物治疗外，还开始使用皮质类固醇（每天 40mg 泼尼松片）。术后第一周末，出血性视网膜血管炎的临床体征开始消退，到术后第四周末完全消退。
本报告描述了一例玻璃体视网膜手术后不常见的 TPSS 诊断，很可能是由于眼内棉纤维的存在。这种后段过度炎症通常对局部和全身皮质类固醇治疗有反应。
