How would you approach this case of intraocular inflammation in a pseudophakic patient?

A 65 years old lady had undergone uneventful phacoemulsification eight months ago. Still, three days after surgery, she had an acute reduction of vision, and she is reporting that she couldn't keep up with clinical visits with her primary care ophthalmologist.

She presented to me with a reduced vision of C.F. and floaters with clear anterior segment findings.

Fundus image

Funds image is foggy due to vitritis with multifocal chorioretinal atrophies.

Fundus image has a foggy view due to active vitritis

Optical coherence tomography

OCT scan shows hyper-reflective epiretinal membrane and increased retinal thickness, disorganization of inner retinal layers, Cystic formations, and disturbed ellipsoid zone. The poor image quality is due to vitritis, while topography shows a central increase of retinal thickness along with multifocal areas of serrated edges of the edema.

OCT cross-section showing cystoid macular edema with poor scan quality due to vitritis

OCT topography showing increased central macular thickness

The primary diagnosis is a relapse of intraocular inflammation, causing vitritis with cystoid macular edema.

Management

I decided to treat her with posterior sub tenon triamcinolone acetonide and followed up with her for one month.

The fundus image shows clearance of vitritis, and the symptoms of floaters have subsided along with improved vision up to 20/200.

Fundus image showing clear posterior pole after resolved vitritis post treatment

OCT scan shows improvement and resolution of the edema with some residual microcystic formation and focal disturbance of the ellipsoid zone and inner retinal architecture, with improved OCT scan quality due to clearance of the vitritis. In contrast, topography shows decreased retinal thickness with residual edema in the parafoveal area.

OCT cross-section post treatment showing with residual cystoid macular edema

Topogrphy

Discussion

Injecting steroids helped, in this case, to control intraocular inflammation and resolving vitritis and associated cystoid macular edema, which can substantially improve retinal anatomy and function.

In case of vitritis related to endophthalmitis, it should be treated with pars plans vitrectomyInjecting steroids helped, in this case, to control intraocular inflammation and resolving vitritis and associated cystoid macular edema, which can substantially improve retinal anatomy and function. or injecting intravitreal antibiotics. Offending bacteria can cause necrosis to the retinal tissues, especially photoreceptors, leading to poor visual prognosis.

Comments

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