gms | German Medical Science

Goal: Presentation of two cases of postoperative macular edema secondary to pars plana vitrectomy for postoperative endophthalmitis.

Method: Analysis of visual acuity and macular spectral domain optical coherence tomography (Heidelberg Spectralis^®) in two cases developing macular edema between three weeks respectively fifteen weeks after pars plana vitrectomy for post operative endophtalmitis.

Results: Both patients have been transfered for postoperative endophtalmitis after surgery ex domo.

The first case was initialy operated for macular pucker with pre-existing macular thicknening. Initial visual acuity in our clinic was 0.05. Following the vitrectomy for endophthalmitis, the macular thickening increased 3 weeks after surgery (from 389 µm to 621 µm), but responded to systemic steroid therapy (macular thickness 430 µm). Final visual acuity was 0.6.

The second case of endophthalmitis developed secondary to a cataract surgery, visual acuity was on admission counting fingers.

After an initially uncomplicated outcome, a macular edema developed 15 weeks after vitrectomy for endophtalmitis (macular thickness 595 µm). A complete resolution of macular edema was seen three weeks after oral prednisone introduction (macular thickness 355 µm). No recurrence was observed (last macular thickness 355 µm), final visual acuity was 0.8.

Conclusion: Postoperative macular edema after pars plana vitrectomy for endopthalmitis seems to be a similar clinical finding as an Irvine Gass Syndrome following catact surgery. Similar edemas have also been described after pars plana vitrectomy for retinal detachments and other pathologies. The inflammatory environment in an endophthalmitis might trigger the edema formation, which would explain its response to systemic steroid therapy. It can be argued that the second case could be an Irvine Gass Syndrome since the endopthalmitis developed after an intial cataract surgery, but the edema developed unusually late, 15 weeks after the pars plana vitrectomy.