Chronic post-operative iris prosthesis endophthalmitis in a patient with traumatic aniridia: a case report

Kevin C. Firl,Sandra R. Montezuma

doi:10.1186/s12886-016-0383-1

Abstract

Post-operative endophthalmitis is a serious complication of intraocular surgery which may present acutely or chronically. Chronic post-operative endophthalmitis is characterized by decreased visual acuity, mild pain, and low-grade uveitis several weeks or months after intraocular surgery which may be responsive to corticosteroids, but recur upon tapering. Low virulence organisms such as Propionibacterium acnes are the most common culprit organisms, and treatment most often consists of both intravitreal antibiotic injections and surgery. Aniridia is a condition defined by total or partial loss of the iris and leads to decreased visual quality marked by glare and photophobia. Treatment of complex or severe cases of traumatic aniridia in which surgical repair is difficult may consist of implantation of iris prostheses, devices designed to reduce symptoms of aniridia. Though chronic, post-operative endophthalmitis has been associated with most intraocular surgeries including intraocular lens implantation after cataract removal, it has never been described in a patient with an iris prosthesis. In this case report, we describe the case of a 49year old, male construction worker with traumatic aniridia who experienced chronic, recurrent low-grade intraocular inflammation and irritation for months after implantation of the Ophtec 311 prosthetic iris. Symptoms and signs of inflammation improved temporarily with sub-Tenon's capsule triamcinolone injections. Ultimately after more than 2 post-operative years, the iris prosthesis was explanted, and intravitreal cultures showed P. acnes growth after 5days. Intravitreal antibiotics treated the infection successfully. To our knowledge, this is the first reported case of chronic, post-operative endophthalmitis in a patient with an iris prosthesis. Chronic, post-operative endophthalmitis may be a difficult to identify in the context of traumatic aniridia and iris prosthesis implantation due to other potential etiologies of chronic intraocular inflammation such as implant-induced chafing. Clinicians should suspect chronic, post-operative endophthalmitis in any case of recurrent, low-grade intraocular inflammation.

Highlights

Post-operative endophthalmitis is a serious complication of intraocular surgery which may present acutely or chronically
Post-operative endophthalmitis may be a difficult to identify in the context of traumatic aniridia and iris prosthesis implantation due to other potential etiologies of chronic intraocular inflammation such as implant-induced chafing
chronic post-operative endophthalmitis (CPOE) has been described in association with a variety of intraocular procedures as described above, to our knowledge this is the first time it has been reported in connection with a post-traumatic, iris prosthesis implantation leading to explantation

Summary

Conclusions

We have presented a patient who, after sustaining traumatic aniridia, receiving an Ophtec 311 iris prosthesis, and experiencing 2 years of recurrent intraocular inflammation and pain, was discovered to have culture-positive CPOE and treated successfully with removal of the Ophtec 311 and intravitreal antiobiotics. The diagnosis of CPOE should always be suspected in cases of chronic, post-operative inflammation, but may be complicated by other potential etiologies such as uveitis due to retained cortical material or lens fragments, implant-induced chafing of iris remnant, sympathetic ophthalmia, or unrelated, systemic causes of chronic uveitis [7, 9]. In this case of severe, intraocular trauma followed by iris prosthesis implantation, all of these alternatives to CPOE, especially implant-induced inflammation, entered the differential and may have delayed diagnosis. Abbreviations APOE – acute, post-operative endophthalmitis; CPOE – chronic, postoperative endophthalmitis; VA – visual acuity; OS – left eye

Background

Findings