A Case of Endophthalmitis with Atypical Anterior Symptom by Subconjunctival Dexamethasone Injection after Cataract Surgery

Abstract

Purpose: To report a case of endophthalmitis with non-specific anterior segment symptom by subconjunctival dexamethasone injection and anterior chamber irrigation for the anterior chamber inflammation resulted in delayed diagnosis after cataract surgery.Case summary: A 74-year-old female patient with visual disturbance and anterior chamber inflammation had subconjunctival dexamethasone injection and anterior chamber irrigation after 5 days of cataract surgery. On the 7th day after surgery, the anterior chamber inflammation had decreased without visual acuity improvement and additional subconjunctival dexamethasone injection was done. The next day, she was referred to our hospital because there were no improvements in her visual symptom. When the patient visit our hospital, visual acuity was hand motion and cornea edema was shown. Because of corneal edema, anterior chamber cells were obscure, but it was assumed as 1+ grade. Severe vitreous opacity and increased vitreous cells were observed, so the fundus was barely visible. With diagnosis of endophthalmitis, vitrectomy and intravitreal antibiotic injection were performed. Seven weeks after surgery, best corrected visual acuity increased to 0.6, and there was no sign of recurrence.Conclusions: When the endophthalmitis after cataract surgery was misdiagnosed as toxic anterior chamber syndrome and subconjunctival dexamethasone injection and anterior chamber irrigation were performed, the diagnosis of endophthalmitis could be delayed because the symptoms of the anterior chamber could be non-specific. Therefore, it is important to take careful use of strong anti-inflammation medications after cataract surgery.