Retinal vasculitis and posterior pole "hypopyons" as early signs of acute bacterial endophthalmitis

PURPOSE: To report a case of acute postoperative bacterial endophthalmitis presenting with retinal vasculitis and posterior pole "hypopyons." DESIGN: Observational case report. METHODS: Observational case report. RESULTS: Ln a 73-year-old woman, acute postoperative endophthalmitis presen ted with retinal vasculitis, diffuse retinal hemorrhages, and several poste rior pole "hypopyons" that were collections of yellow-white inflammatory de bris. The inflammation was located primarily in the posterior one;third of the vitreous, and except for severely impaired visual acuity, the classic s igns of acute postoperative endophthalmitis were not present until the next day. An immediate pars plana vitrectomy with intravitreal injection of van comycin, amikacin, and dexamethasone was performed. Vitreous and aqueous cu ltures grew coagulase-negative Staphylococcus species. After intravenous an d topical therapy for endophthalmitis, the inflammation subsided. Eight wee ks after the initial cataract surgery, the best corrected visual acuity of the patient was 20/25, CONCLUSION: Acute postoperative bacterial endophthalmitis may present with atypical clinical signs and inflammation located primarily in the retina an d posterior vitreous. (Am J Ophthalmol 2001;131:800-802. (C) 2001 by Elsevi er Science Inc. All rights reserved.).