Endophthalmitis after Removal of an Intralenticular Foreign Body in Place without Symptoms for 20 Years

Young Choi; Youngsub Eom; Soo Youn Choi; Bo Young Lee; Eun Jee Kim; Su-Yeon Kang; Jong Suk Song; Hyo Myung Kim

doi:10.3341/jkos.2019.60.5.480

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Choi, Eom, Choi, Lee, Kim, Kang, Song, and Kim: Endophthalmitis after Removal of an Intralenticular Foreign Body in Place without Symptoms for 20 Years

Case Report

Journal of the Korean Ophthalmological Society 2019; 60(5): 480-485.

Published online: 15 May 2019

DOI: https://doi.org/10.3341/jkos.2019.60.5.480

Endophthalmitis after Removal of an Intralenticular Foreign Body in Place without Symptoms for 20 Years

Young Choi, MD, Youngsub Eom, MD, PhD, Soo Youn Choi, MD, Bo Young Lee, MD, Eun Jee Kim, MD, Su-Yeon Kang, MD, PhD, Jong Suk Song, MD, PhD, Hyo Myung Kim, MD, PhD

Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea.

Address reprint requests to Youngsub Eom, MD, PhD. Department of Ophthalmology, Korea University Ansan Hospital, #123 Jeokgeum-ro, Danwon-gu, Ansan 15355, Korea. Tel: 82-31-412-5160, Fax: 82-31-412-4267, hippotate@hanmail.net

Received 13 September 2018 Revised 6 October 2018 Accepted 23 April 2019

The Korean Ophthalmological Society

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

We report a case of postoperative endophthalmitis in the cataract patient, associated with removal of an intralenticular foreign body that had remained in place without symptoms for 20 years.

Case summary

A 45-year-old male visited our outpatient clinic complaining of gradual visual loss in his right eye over the past 3 months. In slit-lamp examinations, anterior capsular opacification, nuclear sclerosis, and posterior subcapsular opacity were observed in the right eye. Twenty years before, a tiny metallic projectile had hit his right eye, but slit-lamp examination at the time of injury did not reveal any intraocular foreign body. We decided to undergo cataract surgery. During phacoemulsification, a metallic foreign body was found in the lens and safely removed; then an intraocular lens was implanted. As hypopyon was evident 3 days later, we injected intravitreal antibiotics and applied fortified antibiotic eye drops to the right eye. The anterior chamber inflammation improved and the best-corrected visual acuity recovered to 1.0.

Conclusions

Surgeon should be aware of that endophthalmitis could develop after cataract surgery with removal of an intralenticular foreign body that had been in place for 20 years. But did not trigger inflammation or cause any symptoms as the cataract progressed.

Keywords: Cataract surgery, Endophthalmitis, Intralenticular foreign body

Figures and Tables

Figure 1

Anterior segment photographs of the patients at the first visit. Anterior capsular opacification and nuclear sclerosis were found in the right eye (A) and a small corneal opacity was observed in the center of the right cornea, which was considered to be a sign of previous penetration (B).

Figure 2

Intraoperative photographs. An intralenticular metallic foreign body found during phacoemulsification (red arrow) (A) and the posterior capsule was intact (B).

Figure 3

Removal of an intralenticular metallic foreign body. A balanced salt solution was injected into the back of the metallic foreign body to safely remove it (red arrows) with pressure gradient through the clear corneal incision (A–F).

Figure 4

Anterior segment photographs three days after cataract surgery. Conjunctival hyperemia, hypopyon (A), and anterior chamber exudative reactions (B) are observed.

Notes

This study was supported in part by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science and ICT (2018R1C1B6002794), by a Korea University Ansan Hospital Grant (K1811051), and by Alumni of department of ophthalmology, Korea University College of Medicine in 2018. This work was presented in part at the 118th Meeting of the Korean Ophthalmological Society, Seoul, South Korea, November 3-5, 2017.

^{Conflicts of Interest} The authors have no conflicts to disclose.

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