Preretinal deposits caused by chronic inflammation after cataract surgery: a case report

To report a case of preretinal deposits resulting from persistent chronic intraocular inflammation following cataract surgery. A 70-year-old male patient presented with decreased visual acuity in the left eye and underwent phacoemulsification with intraocular lens implantation at a local hospital. On postoperative day 3, the operated eye developed redness, pain, and further visual decrease. Suspected infectious endophthalmitis after cataract surgery, the patient received systemic intravenous antibiotics (vancomycin), peribulbar injections of corticosteroids (dexamethasone sodium phosphate) and antibiotics (tobramycin ) for one month. Ocular redness and pain improved, but visual acuity showed no significant recovery. The patient was referred to our hospital and underwent pars plana vitrectomy, intravitreal injection (vancomycin + ceftazidime), retrobulbar injection of 20 mg triamcinolone acetonide (TA), and subconjunctival injection of 5 mg dexamethasone. White deposits regularly distributed along retinal vessels were observed on the retinal surface intraoperatively. Following vitrectomy and combined intravitreal anti-infective and anti-inflammatory therapy, the preretinal deposits gradually resolved, and the patient’s visual acuity improved significantly. Persistent chronic intraocular inflammation may be one mechanism leading to preretinal deposits. Pathological examination confirmed that the deposits consisted of neutrophils, lymphocytes, and exudates, consistent with chronic inflammatory lesions. Immunohistochemical results indicated that these cells were derived from blood extravasation, likely associated with sustained chronic inflammation secondary to postoperative infection. Therefore, intravitreal injection alone or combined with vitrectomy remains the first-line treatment for clinically highly suspected infectious endophthalmitis.