Abstract
Only two cases of bacterial endophthalmitis after triamcinolone acetonide (TA)-assisted pars plana vitrectomy (PPV) have been reported. As far as we are aware there has been no report of fungal endophthalmitis occurring after TA-assisted PPV. We report a case of endophthalmitis due to Fusarium after TA-assisted PPV. An otherwise healthy 61-year-old woman suffered from branch retinal vein occlusion with macular edema, which led to reduced visual acuity and metamorphopsia. Because she complained of severe discomfort, TA-assisted PPV was performed to reduce the macular edema. At the end of the surgery 4 mg TA was injected into the vitreous cavity. Two weeks after the surgery her visual acuity had improved to 20/20. Six weeks after the surgery her visual acuity decreased to 20/200 but without pain. Slit lamp examination showed no conjunctival hyperemia and no inflammatory cell infiltration in the anterior chamber. Fundus examination showed several small, creamy-white, circumscribed retinal lesions, epiretinal membranes, vitreoretinal traction, and rhegmatogenous retinal detachment. PPV was performed again. Intra-operative light microscopy revealed filamentous fungi in the epiretinal membrane, which was removed during the second PPV. Five days after the second surgery, retinal detachment recurred. A third PPV with encircling procedures and silicone oil tamponade was performed. Fungal cultures from the epiretinal membrane were identified as Fusarium sp. Seven months after the third surgery the silicone oil was removed. The retina remained attached and visual acuity was 20/200. Any patient who has undergone TA-assisted PPV should be carefully followed up for possible post-operative endophthalmitis, even if the anterior segment abnormality is minor.
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References
Peyman GA, Cheema R, Conway MD, Fang T (2000) Triamcinolone acetonide as an aid to visualization of the vitreous and the posterior hyaloid during pars plana vitrectomy. Retina 20:554–555
Sakamoto T, Miyazaki M, Hisatomi T, Nakamura T, Ueno A, Itaya K, Ishibashi T (2002) Triamcinolone-assisted pars plana vitrectomy improves the surgical procedures and decreases the post-operative blood-ocular barrier breakdown. Graefes Arch Clin Exp Ophthalmol 240:423–429
Mitamura Y, Miyano N, Ohtsuka K (2005) Bacterial endophthalmitis after triamcinolone acetonide-assisted pars plana vitrectomy. Jpn J Ophthalmol 49:538–539
Yamashita T, Doi N, Sakamoto T (2004) Weak symptoms of bacterial endophthalmitis after a triamcinolone acetonide-assisted pars plana vitrectomy. Graefes Arch Clin Exp Ophthalmol 242:679–681
Sakamoto T, Enaida H, Kubota T, Nakahara M, Yamakiri K, Yamashita T, Yokoyama M, Hata Y, Murata T, Miyata K, Uemura A, Kimura W, Ishibashi T (2004) Incidence of acute endophthalmitis after triamcinolone-assisted pars plana vitrectomy. Am J Ophthalmol 138:137–138
Jonas JB (2005) Intravitreal triamcinolone acetonide for treatment of intraocular oedematous and neovascular diseases. Acta Ophthalmol Scand 83:645–663
Moshfeghi DM, Kaiser PK, Bakri SJ, Kaiser RS, Maturi RK, Sears JE, Scott IU, Belmont J, Beer PM, Quiroz-Mercado H, Mieler WF (2005) Presumed sterile endophthalmitis following intravitreal triamcinolone acetonide injection. Ophthalmic Surg Lasers Imaging 36:24–29
Sonoda KH, Enaida H, Ueno A, Nakamura T, Kawano YI, Kubota T, Sakamoto T, Ishibashi T (2003) Pars plana vitrectomy assisted by triamcinolone acetonide for refractory uveitis: a case series study. Br J Ophthalmol 87:1010–1014
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Ataka, S., Kurita, K., Wada, S. et al. A case of mycotic endophthalmitis after triamcinolone acetonide-assisted pars plana vitrectomy. Int Ophthalmol 27, 51–54 (2007). https://doi.org/10.1007/s10792-007-9030-4
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DOI: https://doi.org/10.1007/s10792-007-9030-4