A Case of Postendophthalmitis Delayed-Onset Macula-Sparing Extensive Retinal Vascular Sclerosis.

A 40-year-old female with pseudophakia developed acute endophthalmitis on postoperative day 1 after uneventful floater-only-vitrectomy (FOV). There were dense vitreal opacities with best-corrected visual acuity (BCVA) dropped from 0.6 (preoperative) to hand motion. Immediate revitrectomy with standard-dose intravitreal antibiotics (Ceftazidime and Amikacin) was performed. Vitreous sample showed heavy growth of Staphylococcus epidermidis. Intravitreal Vancomycin was supplemented in addition to fortified topical antibiotics subsequentially. The vitreous cleared up gradually with clear vitreous and normal-looking fundus in 4 weeks; and the BCVA at 6-week was 0.4. However, at a 3-month follow-up, nonhemorrhagic extensive retinal vascular sclerosis with sparing of the posterior pole was found incidentally (Fig. 1). Fundus fluorescein angiogram revealed adequate blood perfusion to the optic disc and the macula. The optical coherence tomography of the macula also looked normal. Panretinal photocoagulation was done to prevent proliferative changes. At the 2-year follow-up, BCVA was maintained at 0.4. The case illustrates that early vitrectomy can yield good anatomical and visual outcomes.[1,2] To the best of our knowledge, this is the first case report on delayed onset postendophthalmitis macular-sparing nonhemorrhagic extensive retinal vascular occlusion. The cause is unknown but may not be related to intravitreal vancomycin as there was no hemorrhagic component.

FIGURE 1

A, Scanning laser ophthalmoscope image at 2-year post-op showing the extensive retinal vascular sclerosis (ghost vessels, white arrows) sparing the peri-papillary and macular regions (outlined by the black dotted line). B, Fundus fluorescein angiogram at the left lower corner showing adequate peri-papillary and macular regions vascular perfusion. C, Optical coherence tomography (OCT) scan over the right upper corner showing normal looking OCT except mild thinning from high myopia (-12D).