Fulminant Culture Negative Endophthalmitis as a New Entity, Toxic Posterior Segment Syndrome?

Abstract

1.1.Purpose: To report an unusual case of sterile versus bacterial endophthalmitis in a post cataract surgery wound leak 1.2.Subject: A 58 year old woman with a past eye medical history of LASIK underwent routine cataract extraction (CE) with lens implant of left eye and presented with a delayed, fulminant endophthalmitis OS on day 19 post CE or 3.5 days after the development of a post-op wound leak. Eye examination OS showed visual acuity (VA) of bare LP. Slit lamp examination revealed an edematous cornea with a 1mm hypopyon. A huge amount of exudate filled the entire posterior segment. 1.3.Results: Patient was treated with intravitreal vancomycin (1mg) and ceftazidime (2mg) and pars plana vitrectomy. Vitreal cultures were negative but initial clinical presentation mimicked a virulentstrep, staph, or pseudomonas endophthalmitis. Her post-operative course showed gradual improvement, reaching baseline VA of 20/30 OS with a normal eye exam. 1.4.Conclusion: Although culture negative bacterial endophthalmitis is common, good visual outcomes with virulent bacteria is not. Fulminant culture negative endophthalmitis with a good visual outcome may be due to a sterile toxic insult, a variation of TASS which we call Toxic Posterior Segment Syndrome (TPSS).