Case Reports

From phaco to evisceration in a 77-year old patient with brunescent cataract 30 years after trauma

Case Report Details

First Author: A.de Boer THE NETHERLANDS

Co Author(s):    R. Nuijts                    

Abstract Details

Purpose:

In most patients phacoemulsification is low-risk surgery with high level patient benefits. Nevertheless, complications still may occur varying from infection, capsule rupture, cystoid macular edema, and retinal detachment. Patients with specific risk factors may be more prone to the development of peroperative and postoperative complications. In this case report we describe the course of a patient with a brunescent cataract after an ocular trauma 30 years ago.

Setting:

University Eye Clinic Maastricht, Maastricht, the The Netherlands.

Report of Case:

A 77-year-old male patient visits our clinic for a second opinion. Thirty years ago he suffered a blunt trauma of an elastic band on the left eye. Since then his vision was decreased, although in the last two years vision deteriorated further to 2/300. His right eye underwent phacoemulsification with IOL implantation in 2014 with postoperative visual acuity of 20/35. In October 2017 cataract surgery was performed of his left eye. One week postoperatively, an OCT of the macula showed cystoid macular edema (CME). The CME was treated with topical NSAIDs (Yellox) and steroids (Predforte) . At 5 months postoperatively, CME had decreased but intra ocular pressure (IOP) increased. On the basis of a suspected steroid response topical steroids were tapered down with a subsequent increase of CME. After intravitreal steroid injection (Ozurdex) CME decreased. However, one year after the phacoemulsification the patient developed an endophthalmitis. An infiltrate around a 10-0 nylon suture was suspected to be the porte d’entrée since Streptococcus pneumonia was cultured from both the suture and the vitreous biopsy. Three weeks following the endophthalmitis a retinal detachment occurred. Because of the complicated course and after careful discussion with the patient a shared decision was taken to abort further treatment. However, a month later the patient developed a painful eye, and a decision to eviscerate the eye was taken.

Conclusion/Take Home Message:

Despite careful decision taking and risk analysis initial successful cataract surgery ended in significant unforeseen postoperative complications that ultimately warranted evisceration of the eye. This underscores the importance of careful decision taking in patients who suffer for decades from visual impairment even if there is deterioration in visual quality in recent years.

Financial Disclosure:

None