Fulminant Culture Negative Endophthalmitis as a New Entity, Toxic Posterior Segment Syndrome?

LoBue, Thomas D

doi:10.15406/aovs.2016.04.00135

Cited by 1 publication

(1 citation statement)

References 28 publications

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“…Based on the unique features in our case, what can be suggested is a diagnosis of TPSS (toxic endophthalmitis). This is similar to what was reported by LoBue and LoBue [ 14 ] after uneventful cataract surgery. The condition mimicked fulminant culture-negative bacterial endophthalmitis but had a good visual outcome posttreatment.…”

Section: Discussionsupporting

confidence: 92%

Postprocedural Endophthalmitis or Postprocedural Intraocular Inflammation: A Diagnostic Conundrum

Busaidi

Al-Hinai

2021

Case Rep Ophthalmol

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We experienced an atypical endophthalmitis occurring post consecutively performed in-office procedures; an intravitreal injection (IVI) of ranibizumab followed by an anterior chamber (AC) paracentesis performed twice in an eye with neovascular glaucoma (NVG). A 52-year-old diabetic male who was asymptomatic developed signs of endophthalmitis and decreased vision without pain in his left eye a few days post-IVI and AC paracentesis. The condition worsened after an initial vitreous tap and injection of antibiotics. Cultures of vitreous and aqueous samples were negative. Complete resolution occurred after a pars plana vitrectomy with IVI of antibiotics and steroid with removal of a dense “yellowish-brown” fibrinous plaque. The absence of pain, presence of a peculiar colored fibrin, mild-to-moderate vitritis without retinitis, negative cultures, and complete recovery despite the fulminant presentation; favor a diagnosis of inflammation over infection. We hypothesize that a micro-leak from a 26-gauge AC tap tract might have served as an entry port for 5% povidone-iodine from the ocular surface thus inciting inflammation. However, an exuberant inflammatory response that can be typically seen in NVG eyes after intraocular procedures cannot be excluded. Various causes of inflammation post-procedures, both toxic and nontoxic should be considered in atypical culture-negative fulminant endophthalmitis cases with good outcome posttreatment. Any minor ocular procedure may carry a risk of such complication. Patient counseling and care must be exercised in performing these procedures.

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Section: Discussionsupporting

confidence: 92%