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45 year old lady who complained of decreased vision OS of one year duration after cataract surgery
Digital Journal of Ophthalmology 1998
Volume 4, Number 19
June 9, 1998
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DV Inglesby MB, BSc, FRCS, FRCOphth | Sunderland Eye Infirmary, Sunderland, United Kingdom
LM Tong MB, BS | Sunderland Eye Infirmary, Sunderland, United Kingdom
Differential Diagnosis
The differential diagnosis of prolonged inflammation after cataract surgery and cystoid macular edema includes:

- Retained lens fragments
- Chronic endophthalmitis
- Auto-immune uveitis (triggered by surgery)

Because of the fluffy white spots on the posterior capsule, there was a suspicion of chronic endophthalmitis FROM an indolent organism. A vitreous biopsy specimen was taken. The intraocular lens implant and capsular bag were removed via a corneal wound and sent for cultures. A pars plana vitrectomy was then performed and the posterior hyaloid face stripped FROM the retina. Subconjunctival cefuroxime and betnesol were given after the procedure.

Bacteriology Results:

Vitreous no organisms on gram stain or culture.
Microscopy/gram staining: fluid FROM IOL and capsular wash showed gram positive cocci.
Overnight culture produced no growth.
Day 6: gram positive pleomorphic rods were seen.
The organisms were sensitive to penicillin, ciprofloxacin and vancomycin, they were resistant to metranidazole.
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