Journal List > J Korean Ophthalmol Soc > v.58(3) > 1010728

Lee, Park, Kwon, Park, and Lee: A Case of Delayed Infective Endophthalmitis Associated with Exposure of Scleral Fixation Knot

Abstract

Purpose

To report a case of delayed infective endophthalmitis associated with exposure of scleral fixation knot.

Case summary

A 35-year-old female was transferred from a local clinic with sudden onset right eye pain under suspicion of uveitis. The patient received vitrectomy, scleral encircling and lensectomy for rhegmatogenous retinal detachment before 16 years. In addition, she underwent secondary scleral fixation of intraocular lens (IOL) 1 year previously. Best-corrected visual acuity was hand motion and intraocular pressure was 28 mmHg. Slit lamp examination revealed diffuse keratic precipitates and anterior chamber reaction was 4 positive. Exposed scleral fixation knot outside conjunctiva at 2 o' clock combined with suppurative discharge was observed. On fundus examination, red reflex was decreased due to vitreous haze. She was diagnosed as infective endophthalmitis associated with exposure of scleral fixation knot. The patient received vitrectomy and intravitreal injection of antibiotics and vitreous culture. After 2 days, IOL removal, silicone oil tamponade and intravitreal injection of antibiotics were performed due to uncontrolled inflammation with accompanying hypopyon. Hemophilus influenza was isolated in the vitreous sample. Removal of silicone oil was performed at 1 month. There was no recurrent inflammation at 1 year and she received scleral fixation of IOL for the second time. At 1 year and 3 months, corrected visual acuity was 0.4 without signs of inflammation.

Conclusions

In cases of exposed scleral fixation knot after IOL insertion, a risk of endophthalmitis exists. Meticulous care is required when fixation knot is exposed due to thinning of overlying conjunctiva.

Figures and Tables

Figure 1

Preoperative clinical findings. (A) The photograph about exposure of the end of a scleral fixation suture through the conjunctiva at two o' clock on the right eye (arrow). (B) Keratic precipitates, hypopyon and severe conjunctival injection. (C) Blurry fundus due to severe vitritis. (D) Classic appearance of vitreous opacities, vitreous strands and membrane on B-scan ultrasonography.

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Figure 2

Postoperative clinical findings. Wide angle fundus photography (A) and optical coherence tomography (B) at 1 year and 3 months after removal of silicone oil. The retina remained attached and there were no signs of active inflammation.

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