Pseudomonas aeruginosa endophthalmitis masquerading as chronic uveitis
A 65-year-old male presented with decreased vision in the left eye of 15-day duration which was gradual in onset, progressive in nature, and associated with pain and redness. The patient had undergone an uneventful cataract surgery in another center, 10 months back, with good visual recovery. He had had similar episodes during the past 4–5 months and had been treated with steroids (topical and systemic) elsewhere for chronic uveitis. As his symptoms worsened with steroids this particular time, the patient was referred to us. He had lost vision in his right eye due to trauma 20 years back.\nOn examination of the left eye, his vision was perception of hand movements. Anterior segment findings included circumcorneal congestion and mild corneal haziness with keratic precipitates and pigments over the endothelium. The anterior chamber showed cells and flare 2+. The pupil was irregular in shape and dilated. The posterior chamber intraocular lens (IOL) was in situ with pigment dispersion on the IOL and yellowish exudates behind it. Details of the fundus were not visualized except for a yellow glow []. B-scan ultrasonography showed multiple dot like echoes with low to moderate reflectivity in the vitreous suggestive of inflammatory debris []. All other systemic investigations were normal except for a low hemoglobin level of 8mg/dL.\nAn aqueous tap was done and subjected to potassium hydroxide (KOH), Gram stain, and culture/sensitivity, followed by intravitreal antibiotics (ceftazidime 2.25 mg/0.1 mL and vancomycin 1 mg/0.1 mL). Aqueous tap revealed P.aeruginosa sensitive to ciprofloxacin. The patient was then started on systemic (tablet 750 mg twice a day) and intravitreal ciprofloxacin (0.2 mg/0.1 mL). As there was clinical improvement with this treatment regimen, repeat intravitreal injections of ciprofloxacin and vancomycin were given on two occasions subsequently. Once the exudates cleared, the patient was restarted on systemic steroids with one dose of intravitreal dexamethasone (400 μg/0.1 mL). The patient improved symptomatically and on the last follow-up at two months, his vision was counting fingers at three meters. Examination of the fundus revealed clearing media with the disc and third-order blood vessels well seen [].