Lens-induced hypopyon uveitis as the presenting manifestation of posterior lens nucleus dislocation following pars-plana vitrectomy: case report

Abstract

A 57-year-old otherwise healthy male presented to our department seven days following uneventful pars-plana vitrectomy with gas tamponade for a superior bullous retinal detachment in the left eye. Ophthalmic examination revealed anterior segment inflammation with hypopyon and fibrinous exudate. Intra-ocular pressure was 28 mmHg. Posterior segment evaluation was difficult to assess due to the presence of anterior capsule opacification and gas bubble. A Toxic Anterior Segment Syndrome was suspected, and the patient was treated with topical and oral corticosteroid medication in combination with anti-glaucomatous therapy. On follow-up, anterior segment inflammation and ocular hypertension improved. On day ten post-operatively, ocular ultrasonography demonstrated lens material inferiorly with attached retina. The final diagnosis of posterior lens nucleus dislocation with lens-induced uveitis was retained. The patient underwent an uneventful second vitrectomy with aspiration of the dislocated lens nucleus and sulcus three piece-lens implantation. On last follow-up, visual acuity was 20/50 with no relapsing of ocular inflammation and the retina remained reattached.

Lens-induced uveitis following pars plana vitrectomy

“…If severe inflammation is observed after a single ppvit (without any concomitant intraocular surgery like phacoemulsification, glaucoma surgery, implantation of secondary intraocular lens, etc.) causes such as endophthalmitis, sympathetic ophthalmia, and lens-induced uveitis secondary to traumatic crystallin lens damage should also be suspected [3,4].…”

“…If severe inflammation is observed after a single ppvit (without any concomitant intraocular surgery like phacoemulsification, glaucoma surgery, implantation of secondary intraocular lens, etc.) causes such as endophthalmitis, sympathetic ophthalmia, and lens-induced uveitis secondary to traumatic crystallin lens damage should also be suspected [3,4].In this article, we will introduce a patient who suffered from severe inflammation of the anterior segment and nodular infiltration foci on the iris two weeks after ppvit and was finally reoperated with a diagnosis of uveitis secondary to posterior capsule lens rupture.…”