Troubleshooting an Iris Mass in a Pseudophakic eye: A Case study
Accept poster if oral is not possible ?
Yes
Purpose
To discuss a challenging case of iris mass in a pseudophakic patient
Methods
A 58-year-old male presented with left eye pain and blurring for 3 days. A known diabetic with UTI 10 days back treated with i.v. antibiotics. H/o uneventful left eye Phaco + PCIOL 2 months back. His BCVA was OU 6/9. Left eye IOP was 32, AC 2+ cells and a 2*2 mm fluffy yellow mass on temporal pupillary margin. Posterior Segment was normal. Systemic tests were negative. AC tap grew Aspergillus fumigatus; patient received intra cameral voriconazole injection, topical antibiotic-steroid drops and 8 weeks of oral voriconazole following which the lesion completely resolved. However, lesion recurred a month later; repeat AC tap was sterile. Repeat intra cameral voriconazole+moxifloxacin injections were given at weekly interval for 3 weeks to reduce lesion size followed by sectoral iridectomy of affected iris. HPE was inconclusive;revealed only inflammatory cells. Topical drops were tapered; patient was asymptomatic at 1 month follow up. However, lesions recurred on IOL surface at same location 1 month later. Patient then underwent excision of lesion and localized capsular tissue. Culture was suggestive of Propionibacterium acnes, sensitive to vancomycin&moxifloxacin . Intra cameral vancomycin+ moxifloxacin injections were given at weekly intervals for 3 weeks with complete resolution of lesions. Patient is currently asymptomatic with BCVA 6/9 and normal IOP at 3 months follow up.
Results
Diagnostic dilemma between endogenous and delayed onset post op endophthalmitis can pose a challenge to treating physician.
Conclusion
Propionibacterium can present as an Iris mass lesion post operatively and pose diagnostic challenges to the managing physician.
Conflict of interest
No
1
Last name
MITTAL
Initials of first name(s)
H
Department
Ophthalmology
City
New Delhi
Country
India
2
Last name
Narula
Initials of first name(s)
A
Department
Ophthalmology
City
New Delhi
Country
India
3
Last name
Mehta
Initials of first name(s)
A
Department
Ophthalmology
City
New Delhi
Country
India
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