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January 11, 2008. This pleasant 61-year-old man has a complex recent history. He is doing fine. He had cataract surgery done on the right eye September 26th and then after the cataract surgery he was told his eye was a little inflamed. He was kept on steroids and then he developed a huge floater just before Thanksgiving. He was seen emergently and there was no retinal tear in the right eye. There was concern because he had previously been treated for retinal tear in the left eye, but he was found to have an escalating uveitis. He had what sounds like a posterior sub Tenon and Kenalog injection behind the right eye December 14, 2007, and it did not help the eye at all. He still has dense floaters in the eye and his vision is hazy most of the time. The eye does not hurt. Today and saw a pattern of keratic precipitates that was suggestive of endophthalmitis and he was sent to me here for urgent evaluation. His vision in the left eye is good. VISUAL ACUITY: OD 20/60. Pinhole is 20/30. OS 20/200. Pinhole is 20/25. IOP: OD 18, OS 15. SLIT LAMP EXAM: The right eye has white conjunctiva. There are 2+ keratic precipitates, mostly on the inferior half of the cornea. There is 2+ anterior chamber. The iris is round. There are no iris nodules. There is a white plaque in the periphery of the capsule, extending from the 11 o’clock around to 3 o’clock. The central capsule is clear. The left eye is quiet with trace nuclear sclerosis. EXTENDED OPHTHALMOLOSCOPY: OD: Vertical C/D ratio is 0.3. There is 3+ vitreous cells. The macula is dry. There is no evidence of any retinitis or vasculitis or snowballs in the inferior vitreous base. OS: Vertical C/D ratio is 0.3. There is posterior vitreous separation. There is laser to superonasal retinal tear. IMPRESSION: 1. CHRONIC ENDOPHTHMALITIS – RIGHT EYE 2. PROBABLE P. ACNES ENDOPHTHALMITIS – RIGHT EYE 3. HISTORY OF RETINAL TEAR – LEFT EYE DISCUSSION: I explained to the patient the clinical course including the inflammation after the cataract surgery, the non-responsiveness to Kenalog injection, the keratic precipitates and the white plaque in the capsule are all highly suggestive of appropriately bringing her back to acnes endophthalmitis. The treatment approach for this are varied. Removing the lens, removing the capsule, and injecting the eye with Vancomycin usually takes care of it, but if possible, it is nice to leave the lens and try to treat with antibiotics. I injected the eye with Vancomycin today, taking care to angle the needle into the capsule. I asked him to continue using Econopred drops and I also gave him a sample of antibiotics to take. I asked him to return for a check Tuesday, at which point I will inject the eye again with Vancomycin and then give the eye a few weeks to see if it will settle down with just that treatment. If not, it would be reasonable to do a vitrectomy with the intent to removing as little of the capsule as possible and retreating him with Vancomycin and then ultimately, I told him it is possible to remove everything and that usually takes care of the infection. I will have him see you back periodically as well. Note: patient did ultimately require a vitrectomy and removal of the intraocular lens and capsule. He did culture for P. acnes at that time.

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Propionibacterium acnes endophthalmitis with capsular plaque and uveitis193 views61 year old man with inflammation after cataract surgery who ultimately needed removal of intraocular lens and capsule to quiet eye.00000
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Propionibacterium acnes endophthalmitis with capsular plaque and uveitis350 views61 year old man with inflammation after cataract surgery who ultimately needed removal of intraocular lens and capsule to quiet eye.00000
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Propionibacterium acnes endophthalmitis with capsular plaque and uveitis345 views61 year old man with inflammation after cataract surgery who ultimately needed removal of intraocular lens and capsule to quiet eye.00000
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Propionibacterium acnes endophthalmitis with capsular plaque and uveitis580 views61 year old man with inflammation after cataract surgery who ultimately needed removal of intraocular lens and capsule to quiet eye.00000
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Propionibacterium acnes endophthalmitis with capsular plaque and uveitis337 views61 year old man with inflammation after cataract surgery who ultimately needed removal of intraocular lens and capsule to quiet eye.44444
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January 11, 2008. This pleasant 61-year-old man has a complex recent history. He is doing fine. He had cataract surgery done on the right eye September 26th and then after the cataract surgery he was told his eye was a little inflamed. He was kept on steroids and then he developed a huge floater just before Thanksgiving. He was seen emergently and there was no retinal tear in the right eye. There was concern because he had previously been treated for retinal tear in the left eye, but he was found to have an escalating uveitis. He had what sounds like a posterior sub Tenon and Kenalog injection behind the right eye December 14, 2007, and it did not help the eye at all. He still has dense floaters in the eye and his vision is hazy most of the time. The eye does not hurt. Today and saw a pattern of keratic precipitates that was suggestive of endophthalmitis and he was sent to me here for urgent evaluation. His vision in the left eye is good. VISUAL ACUITY: OD 20/60. Pinhole is 20/30. OS 20/200. Pinhole is 20/25. IOP: OD 18, OS 15. SLIT LAMP EXAM: The right eye has white conjunctiva. There are 2+ keratic precipitates, mostly on the inferior half of the cornea. There is 2+ anterior chamber. The iris is round. There are no iris nodules. There is a white plaque in the periphery of the capsule, extending from the 11 o’clock around to 3 o’clock. The central capsule is clear. The left eye is quiet with trace nuclear sclerosis. EXTENDED OPHTHALMOLOSCOPY: OD: Vertical C/D ratio is 0.3. There is 3+ vitreous cells. The macula is dry. There is no evidence of any retinitis or vasculitis or snowballs in the inferior vitreous base. OS: Vertical C/D ratio is 0.3. There is posterior vitreous separation. There is laser to superonasal retinal tear. IMPRESSION: 1. CHRONIC ENDOPHTHMALITIS – RIGHT EYE 2. PROBABLE P. ACNES ENDOPHTHALMITIS – RIGHT EYE 3. HISTORY OF RETINAL TEAR – LEFT EYE DISCUSSION: I explained to the patient the clinical course including the inflammation after the cataract surgery, the non-responsiveness to Kenalog injection, the keratic precipitates and the white plaque in the capsule are all highly suggestive of appropriately bringing her back to acnes endophthalmitis. The treatment approach for this are varied. Removing the lens, removing the capsule, and injecting the eye with Vancomycin usually takes care of it, but if possible, it is nice to leave the lens and try to treat with antibiotics. I injected the eye with Vancomycin today, taking care to angle the needle into the capsule. I asked him to continue using Econopred drops and I also gave him a sample of antibiotics to take. I asked him to return for a check Tuesday, at which point I will inject the eye again with Vancomycin and then give the eye a few weeks to see if it will settle down with just that treatment. If not, it would be reasonable to do a vitrectomy with the intent to removing as little of the capsule as possible and retreating him with Vancomycin and then ultimately, I told him it is possible to remove everything and that usually takes care of the infection. I will have him see you back periodically as well. Note: patient did ultimately require a vitrectomy and removal of the intraocular lens and capsule. He did culture for P. acnes at that time.