PMC3959040_01
(a and b) The clinical appearance of the patient's right eye at presentation with ciliary injection, dark hypopyon and stromal haze (red arrow in 1b). (c and d) His B-scans showing no evidence of endophthalmitis on initial scan (c) then increasing vitreous opacities and RC layer thickening with suspected endophthalmitis on repeated examination (d)
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F1
There was no localized corneal infiltrate, but ring deep corneal dense haze was noticed possibly representing the edges of a previous laser-assisted in situ keratomileusis (LASIK) flap [Figure 1a and b]. His initial B-scan showed very mild vitreous opacity and no RC layer thickening, therefore was not considered to be typical of endophthalmitis [Figure 1c]. His repeated B scans over 4 days following admission revealed increasingly dense organized vitreous opacities and significant retina and choroid (RC) layer thickening suggestive of early endophthalmitis [Figure 1d] for which AC washout, vitreous tap and intravitreal antibiotics were given in the form of vancomycin 1 mg/0.1 ml, ceftazidime 2.25 mg/0.1 ml, and cefuroxime 1 mg/0.1 ml.
(a) Histologic smear of the aqueous showing the predominant polymorphonuclear leukocytes (hematoxylin and eosin, original magnification x400). (b) Blood agar plate showing the bacterial colonies with surrounding beta hemolysis. (c) The clinical appearance of the right eye cataract and posterior synechiae. (d) Postoperative slit-lamp photo of his right eye with intraocular lens (IOL) in the capsular bag
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F2
Moderate number of polymorphonuclear leukocytes were also present [Figure 2a]. The aqueous fluid culture proved bacterial growth identified as Listeria monocytogenes in the blood agar plate [Figure 2b] and brain heart infusion (BHI) broth. The patient subsequently developed cataract for which he underwent phacoemulsification with posterior chamber intraocular lens (PC-IOL) implantation 4 weeks after his admission [Figure 2c]. The slit lamp examination showed corneal + 2 edema and haze, total peripheral anterior synechia with shallow AC, stable IOL, and hazy fundus view [Figure 2d].