gms | German Medical Science

Purpose: To present a clinical case of combined phacoanaphylactic and bacterial endophthalmitis occurred after vitrectomy during vitreous cavity tamponade with silicone oil (SO).

Methods: A patient underwent un uneventful 25G three-port vitrectomy with SO tamponade for proliferative diabetic retinopathy and hemophthalmia of the left eye. In 1 month he developed inflammatory process and progressing of pre-existing cataract. Anterior chamber lavage with bacterial seeding of the aqueous and intracameral antibiotic injection was performed. In spite of this, the patient got worse, IOP elevated up to 40 mm Hg, and 2.5-mm hypopyon appeared. The lens became thinner and more transparent. Cortex migration outside capsular bag was suspected. Ophthalmoscopy was impossible due to opaque lens. Two days later, cortex removal was performed, after which a posterior capsule defect and lens nucleus luxated into the SO bubble were found. The lens was relocated into the anterior chamber and removed. Then, SO and cortex were removed from the vitreous cavity. IOL was not implanted. Antibiotic was injected into the vitreous cavity.

Results: Next day positive dynamics was marked; inflammation has ceased, retina was attached. The results of bacterial seeding showed Staphylococcus aureus growth. In 20 days, the eye was quiet, visual acuity with aphakic correction was 0.05.

Conclusions: During SO tamponade, development of combined bacterial and phacoanaphylactic endophthalmitis is possible. Treatment tactics must be defined by clinical manifestations. The described step-by-step surgical tactics seems to be justified and aimed at interruption of the main units of the pathological process.