Clinical case of chronic postoperative endophthalmitis

Relevance In chronic postoperative endophthalmitis, the clinical picture develops 1.5–2 weeks after surgery and resembles sluggish uveitis [1–4]. Diagnosis of chronic postoperative endophthalmitis is a difficult task, especially when fungal flora acts as an etiologic factor [2, 5, 6]. Electron microscopy, which has recently received a good evidence base, can be used as an additional diagnostic tool for chronic postoperative endophthalmitis. Objective To demonstrate the possibility of using electron microscopy in the diagnosis of chronic postoperative endophthalmitis of fungal etiology using a clinical example. Material and methods Patient P., 67 years old, developed a picture of chronic endophthalmitis 10 days after PEC with IOL. Endovitreal intervention was performed with intraoperative OCT control [7]: vitrectomy, anterior chamber lavage, capsular bag lavage, intravitreal administration of a combination of antibacterial solutions (vancomycin and ceftazidime). Before the operation, cultures were taken from the fluid of the anterior chamber and vitreous cavity for bacteriological examination and light electron microscopy (SEM) with material fixation using a patented technology. Results According to the results of the bacteriological examination on the 5th day, a colony of Corinebact. Xerosis grew in samples from the vitreous cavity. According to the SEM results obtained on the day of the operation, fungi with a micellar structure were detected in the material from the vitreous cavity. When the patient was discharged from the hospital on the 7th day after the operation, obvious positive dynamics were observed against the background of antibiotic therapy. Three weeks after the surgery, against the background of discontinuing antibiotic therapy and reducing anti-inflammatory therapy, the patient noticed the previous symptoms, and therefore returned to the institute. A repeated endovitreal intervention was performed with extraction of the IOL with the capsular bag and intravitreal administration of antibacterial drugs. Samples were taken from the fluid of the anterior chamber, vitreal cavity, capsular bag and sent for bacteriological examination and SEM. According to the results of the first study, no pathogen was detected, according to the SEM results, a fungal agent was detected. Considering the long course of the process, relapses, despite systemic antibacterial therapy, repeated SEM results with the detection of fungal flora, a diagnosis was made - chronic postoperative endophthalmitis of fungal etiology. In this connection, systemic antifungal therapy was prescribed. After 1 month of treatment, stable visual functions were noted, and biomicroscopy showed no inflammatory reactions in the anterior and posterior segments of the eye. Conclusion Based on our clinical example, it can be assumed that SEM: 1) allows for a short preliminary determination of the etiology of endophthalmitis, which plays a key role in the implementation of appropriate etiotropic therapy; 2) SEM makes it possible to suspect a particular pathological agent that caused endophthalmitis even against the background of previously administered antibiotic therapy. Key words: vitrectomy; endophthalmitis; intravitreal administration of antibiotics; postoperative eye inflammation; electron microscopy; bacteriological examination