Vitreous hemorrhage as the initial presentation of postoperative endophthalmitis.

Abstract

To describe a patient with postoperative endophthalmitis whose only abnormal finding at presentation was a vitreous hemorrhage. Interventional case report. A 68-year-old diabetic woman underwent cataract extraction with intraocular lens implantation in the left eye. Three days after surgery, she had painless loss of vision, minimal anterior chamber inflammation, and dense vitreous hemorrhage in the left eye. On the fourth postoperative day, significant anterior chamber inflammation developed with fibrin and a hypopyon. During vitrectomy with intravitreal antibiotic injection, an area of retinitis surrounding an eroded retinal blood vessel was found. Cultures of undiluted vitreous fluid grew coagulase-negative Staphylococcus organisms. The endophthalmitis resolved and 20 months later, her best-corrected visual acuity had improved to 20/40. Postoperative endophthalmitis may present as a vitreous hemorrhage, secondary to retinitis and erosion of a retinal blood vessel.