When A Post-Operative Inflammation Hides A Cmv Uveitis

To report a case of cytomegalovirus uveitis declared one month after phacoemulsification cataract surgery in a patient without a known history of viral infection as a reminder to consider viral uveitis as a diagnosis in the presence of unusual inflammation after cataract surgery.

Ophthalmology department of the hospital of Poissy – Saint Germain en Laye (FRANCE).

A seventy-three-year-old patient presenting in the ophthalmology department with progressive vision loss. The patient has a history of diabetes mellitus, high blood pressure, anthracosic adenopathy, and ocular hypertension treated with topical beta blockers. During initial examination, the best corrected visual acuity was 20/40 in both eyes. The corneal examination revealed a mild cornea guttata. The anterior chamber was calm, with no precipitates. A grade 2 nuclear cataract was noted, and the fundus examination was normal.

Phacoemulsification and implantation of a hydrophobic foldable lens were performed in both eyes. Tapered doses of topical dexamethasone 0.1% and indomethacin 0.1% were prescribed for 30 days. At 1-month follow-up, anterior chamber inflammation with mild ocular hypertension appeared in the left eye; it was initially managed with higher doses of topical dexamethasone and oral acetazolamide. During follow-ups, granulomatous precipitates with corticosteroid-dependent inflammation were observed; Vitreous was calm; and fundus examination was normal. An anterior chamber puncture was performed, and viral PCR analysis of the aqueous humor revealed a high level of cytomegalovirus DNA. The patient was treated with oral ganciclovir and topical dexamethasone resulting in a favorable outcome.

Postoperative inflammation may be challenging. Endophthalmitis and inflammatory rebound are the first diagnoses to consider in case of post-operative inflammation. Viral infection should be suspected in case of unusual evolution. Anterior chamber puncture and PCR analysis are essential for confirming the diagnosis. Preoperative anamnesis should be meticulous to detect any history of viral infection and to prescribe preventive treatment such as topical ganciclovir. Fundus examination is essential to rule out associated viral retinitis.