Dept of Ophthalmology, Command Hospital (Air Force), Bangalore, India.
Rom J Ophthalmol. 2024 Apr-Jun;68(2):182-186. doi: 10.22336/rjo.2024.34.
This case report aimed to describe the unusual clinical presentation and histopathological features of post-injection endophthalmitis. A 56-year-old male phakic patient with diabetic retinopathy received an intravitreal injection (Bevacizumab as per the patient) for neovascular glaucoma elsewhere and presented to our center one day after the dose with hypopyon. The eye was relatively white without pain or lid oedema. The patient was treated as a case of post-injection endophthalmitis with two doses of intravitreal antibiotics 48 hours apart. During the follow-up, he developed a Covid infection. After one week, when the media cleared, white exudates were seen in the vitreous cavity with a relatively healthy retina. He was taken up for pars plana vitrectomy and vitreous biopsy for histopathological study. The microscopic examination of vitreous aspirate revealed crystalline deposits without any microorganisms. Two control slides, one with a mixture of intravitreal antibiotics, which were previously injected, and the other with fresh Triamcinolone were also examined. Although the findings of the drug mixture did not match the vitreous aspirate, they matched with triamcinolone, which established it as a case of pseudo endophthalmitis due to triamcinolone injected elsewhere. Initially, it seemed like a straightforward case of post-injection endophthalmitis, but a further examination of the vitreous aspirate showed that it was pseudoendophthalmitis due to an intravitreal triamcinolone injection. Despite the patient being phakic, neovascularization or elevated intraocular pressure may have led to the disruption of the blood-ocular barrier and the migration of Triamcinolone into the anterior chamber. The case's uniqueness lies in being the first reported case of pseudo endophthalmitis in a phakic patient with an intact lens iris diaphragm. The case also highlighted the judicious use of available resources and out-of-the-box thinking to reach a diagnosis that may not always be obvious. TA = Triamcinolone acetonide, AC = Anterior chamber, IVB = Intravitreal Bevacizumab, PL = Perception of light.
本病例报告旨在描述注射后眼内炎的不寻常临床表现和组织病理学特征。一名 56 岁男性、无晶状体患者，患有糖尿病视网膜病变，因新生血管性青光眼在其他地方接受了玻璃体腔内注射（根据患者情况为贝伐单抗），并在剂量后一天出现前房积脓来到我们中心。眼睛相对较白，没有疼痛或眼睑水肿。患者被诊断为注射后眼内炎，给予 48 小时间隔的两次玻璃体腔内抗生素治疗。在随访过程中，他感染了新冠病毒。一周后，当介质清除后，在玻璃体腔中可见白色渗出物，视网膜相对健康。他接受了经睫状体平坦部玻璃体切除术和玻璃体活检进行组织病理学研究。玻璃体液抽吸的显微镜检查显示有结晶沉积物，但没有任何微生物。还检查了两个对照载玻片，一个载玻片上混合了之前注射的玻璃体内抗生素，另一个载玻片上混合了新鲜曲安奈德。虽然药物混合物的发现与玻璃体液抽吸物不匹配，但与曲安奈德匹配，这表明这是由于在其他部位注射曲安奈德引起的假性眼内炎。 最初，这似乎是一个简单的注射后眼内炎病例，但对玻璃体液抽吸物的进一步检查表明，这是由于玻璃体内曲安奈德注射引起的假性眼内炎。尽管患者为无晶状体，但新生血管或眼内压升高可能导致血眼屏障破坏和曲安奈德迁移到前房。该病例的独特之处在于，这是首例报告的在无晶状体、晶状体虹膜隔完整的患者中发生假性眼内炎的病例。该病例还强调了明智利用现有资源和创新思维来做出诊断的重要性，因为诊断并不总是显而易见的。 TA = 曲安奈德，AC = 前房，IVB = 玻璃体内贝伐单抗，PL = 光感。
