Eyeworld

EW NEWS & OPINION September 2015 29 case that created concern were larger and more discrete with less associat- ed flare than I am used to seeing in a situation caused by surgical trauma; while not quite specifically pathog- nomonic of infection, they certainly raised a flag. Fortunately, the patient did extremely well with early aggres- sive treatment. EW Contact information Beiko: georgebeiko@hotmail.com her essentially plano. I decided that a lens exchange was the best refrac- tive option here and made a deci- sion that even if I could not free up both haptics by dissection, I would be committed to amputate them if needed. This obviously is an option I could not choose were I to rotate the current IOL and leave it in place so I felt there was greater freedom in this approach. I also felt that even if one or both amputated haptic remnants were left behind, the new implant would be at a different axis so it should not cause a problem. The lens exchange was carried out uneventfully and the patient came in the next day still dilated but 20/20 uncorrected OS and extremely happy. Her auto refraction on day 1 was plano. When I examined her at the slit lamp the implant was in perfect position, but I noticed the presence of some large cells in the anterior chamber that I thought were a bit atypical in appearance. I decided to put her on oral moxifloxacin and watch her very closely. I saw her back in the office 16 hours later and her vision was still 20/25 but she commented that it was not quite as good as the previous day and she was aware of some new floaters in her vision. The eye was still white and quiet, but there was a slight increase in the number of large cells I saw in the anterior chamber, and I also saw some cells in the anterior vitreous. At this point I felt that she could have possible early endoph- thalmitis and referred her to a retina colleague who injected her with vancomycin and ceftazidime. Her anterior chamber cells and floaters resolved over the next few days, which I thought was probably indic- ative of an early infection nipped in the bud. Dr. McKee said: "I do believe that this was a case of early endoph- thalmitis. Recently a similar epi- sode occurred in one of my routine cataract patients. He was 20/20 on postop day 1. On postop day 3 at exactly noon he noticed that "something just wasn't right" with his vision. I saw him at 1:00 p.m. and noticed a few cells that where just a little plump and certainly not there on postop day 1. I immediate- ly referred him to a retina specialist who noticed an increase in these cells by 3:00 p.m. He was injected with vancomycin and ceftazidime just 4 hours after the symptoms began. I followed him very closely and watched these cells completely disappear over the next 24–48 hours with no increase in the steroid dosing. He always maintained 20/20 vision and never seemed too wor- ried. I found the whole episode to be very scary indeed. The cells looked just like the ones in your pictures." Like Dr. McKee's example my patient maintained excellent vision throughout and is now a few months postoperative, stable off medication with 20/20 vision and very happy. I believe that the anterior chamber cells I saw in this Donnenfeld: ericdonnenfeld@gmail.com Hill: k7wx@earthlink.net McKee: mckeemd@icloud.com Safran: safran12@comcast.net Watch a video of this case on EyeWorld Clinical rePlay now! clinical.ewreplay.org

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