Late aseptic endophthalmitis after cataract surgery

Late aseptic endophthalmitis occurs four to eight weeks after an uncomplicated cataract extraction. The eye is red and there is a marked vitreous inflammatory reaction. The vision is decreased significantly and the anterior hyaloid face is ruptured with vitreous strands adherent to the surgical incision. Anterior chamber and vitreous cultures are negative for bacteria or fungi. A favorable response is obtained with systemic corticosteroids in high doses. Antibiotics are not necessary. The differential diagnosis includes bacterial endophthalmitis, fungal endophthalmitis, the vitreous wick syndrome, chronic postoperative iridocyclitis, and the Irvine-Gass syndrome. The anterior chamber culture is usually positive in bacterial endophthalmitis and the prognosis is poor. Fungal endophthalmitis responds favorably to corticosteroids and often presents with hypopyon. The vitreous wick syndrome presents with opacification of the vitreous which results from the externalization of a vitreous strand through the corneal wound. Chronic postoperative iridocyclitis occurs early after surgery and becomes chronic. It may be due to foreign material left in the anterior chamber, retained lens material, or non-suppurative organisms. Aseptic endophthalmitis differs from the Irvine-Gass syndrome in that the latter doesn't present with vitreous opacification or vitreous inflammation. The etiology of aseptic endophthalmitis is still unclear; however, a sudden late rupture of the anterior hyaloid face with adherence of the vitreous strand to the interior aspect of the surgical wound sets up a condition which lends to an intense vitreous reaction.