A White Eye With A Dark Secret

To highlight how follow up of uneventful cataract surgery can turn out to be with sinister turn of events.

Department of ophthalmology, Yenepoya Medical College.

65 yr male diabetic,myopic 6/6 BCVA on POD1 following uneventful MICS.Advised routine postoperative medications.POD3 he reports back
with HM vision, painfree with white eye ,2mm hypopyon.B-scan was echo free.Aggressive topical steroids started. POD4 vision was HM with vitritis. He received intravitreal ceftazidime +vancomycin with AC tap.Advised admission for diabetic management, initiation of oral steroids
POD 6 started on oral steroids,intravitreal antibiotics, dexamethasone under supervision. Vision improved from HM to CF 2m with fluctuating sugars.POD8 Near total vitrectomy was done.Peripheral retinal degenerations lasered.POD18 vision is HM with near total rhegmatogenous retinal detachment.retinal detachment  surgery with oil done.

BCVA following intravitreal injections and oral steroids improved from HM to CF 2m to 3m. However post vitrectomy day 1 his vision improved to 6/6 and was discharged with Insulin and tapering oral steroids. Following retinal detachment surgery BCVA continues to be 6/12 at 2 months f/u.Interestingly throughout the course of events patient was painfree with White eye

Sterile endophthalmitis is rarely reported following an uneventful cataract surgery.  Intravitreal and systemic steroids remain the mainstay of treatment in these situations. However severe vitritis with equivocal response might need vitrectomy for faster visual recovery and to prevent inflammatory damage.  It should be executed with caution especially in myopes with peripheral retinal degenerations who might progress to retinal detachments inspite of barrage laser.