Endophthalmitis Mimicking Keratouveitis After Flanged Intrascleral Iol Fixation

To demonstrate a case of chronic endophthalmitis after flanged IOL fixation. The patient had been misdiagnosed and treated as keratouveitis. Eventually, successful treatment can be achieved with corneal transplantation combined with IOL removal. 

Siriraj Hospital, Mahidol University, Thailand

The patient was referred to our hospital with uncontrolled ocular inflammation after receiving the flanged IOL fixation. He had been diagnosed and treated as herpes keratouveitis for 4 months. At presentation, multiple clumps of keratic precipitates and localized corneal edema were detected. There also were multifocal posterior corneal infiltrations, suggesting infectious keratitis. Although the vitreous revealed indefinitely heterogeneous, endophthalmitis was suspected. Therefore, aqueous tapping was performed and the debris overlaying on the IOL was aspirated, sent for smears and cultures, followed by an intravitreal antibiotic injection.

The laboratory reported positive culture for Escherichia coli, sensitive to the antibiotics given. However, the clinical condition was not improved. Therapeutic corneal transplantation combined with IOL removal was scheduled. The cauterized knobs of the flanged IOL were identified first, and then they were released from the surrounding tissue. Next, the patient’s cornea was trephined and opened. The IOL was removed through the open-sky globe, followed by vitrectomy. Finally, the globe was closed with the donor cornea. Intravitreal antibiotics were injected at the end of the surgery. Postoperative inflammation gradually subsided and steroid eye drops were introduced subsequently. Best-corrected vision was improved to 20/50 at 1month.

Postoperative endophthalmitis may mimic uveitis, which can mislead us the diagnosis. Pathogens residing in the scleral tunnels might be a source of chronic endophthalmitis in patient underwent intrascleral IOL fixation. Awareness of this condition brings about an early diagnosis and timely management, which ultimately results in satisfactory visual outcome.