Treatment of Macular Edema Following Delayed Endophthalmitis with Ozurdex


Treatment of Macular Edema Following Delayed Endophthalmitis with Ozurdex by Maria-Begona Pastor-Nieto, Jesus Zarallo-Gallardo, Spain


Clinical Report:

We present the case of an 81 year-old lady who was operated of cataracts in her left eye. The surgery was uneventful. An acrilic intraocular lens was implanted. One month after the surgery her visual acuity (VA) was 1.0 without correction. Six weeks later she came to the emergency service complaining of moderate pain and progressive decrease in VA for a week. Her VA was 0.2, clinical signs were blepharitis, moderate red eye, no epithelial defect, 1.2 mm hypopyon, severe anterior chamber reaction, white collection in capsular bag and moderate vitritris. Aqueous humor samples were taken and empirical intravitreous treatment was initiated with ceftazidime 2.25 mg/0.1 ml and vancomycin 1 mg/0.1 ml, and topical dexamethasone, tobramycin and cycloplegic. Oral treatment with clarithromicin 500 mg bid was also started. Forty eight hours later her visual acuity had improved to 0.5. Hypopyon and vitritis decreased and the intravitreal treatment was repeated adding intravitreal dexamethasone 0. 4 mg / 0.1 ml. Ten days later visual acuity remained stable in 0.4. Aqueous humor cultures were negative. Intraocular inflammation was much better showing no hypopyon and only mild vitritis. Twenty days after the last intravitreal treatment the patient came back to the emergency service complaining of visual loss. Her VA was 0.05 in LE. There was no inflammation in anterior chamber nor vitritis. Fundoscopy was performed and a remarkable macular edema was found and confirmed by OCT. The patient was scheduled for an intraviteal injection of dexamethasone implant (Ozurdex). The visual acuity improved from 0.05 to 1.0 after only ten days. Two months after the injection clinical situation remained stable without macular edema and 1.0 VA. Intraocular pressure is 14 mmHg and there are no signs of inflammation.


Intravitreal dexamethasone implant is a good choice in cases of macular edema due to severe inflammation in eyes that have suffered a chronic postoperative endophthalmitis.



Maria Begona Pastor-Nieto
Madrid, Spain
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