[Endophthalmitis phakoanaphylactica with anterior uveitis of the partner eye]

Phakoanaphylactic endophthalmitis is a rare but deleterious complication of surgical, traumatic, or spontaneous lens capsule perforation. The authors describe a 79-year-old patient who developed severe endophthalmitis four days after extracapsular cataract extraction and implantation of a posterior chamber lens. The inflammation, which led to phthisis and eventually necessitated enucleation, was characterized by an atypical hypopyon in the form of a conglomerate of fibrin and cellular elements originating at pupillary level. The laboratory workup revealed a chronic lympho-granulomatous inflammation with epitheloid cells and polynuclear giant cells near the lens capsule, confirming the clinical diagnosis of a phakoanaphylactic endophthalmitis. Ten weeks after the cataract extraction a persistent iridocyclitis developed in the fellow eye, which had been free of inflammation up to that point. Hypotonia of the globe, a previous opacification of the first eye, the close chronological relationship with the phakogenic inflammation of the first eye, and clues from the literature suggest a sympathizing phakoanaphylactic endophthalmitis in the fellow eye. Differential diagnosis to rule out other postoperative inflammatory reactions, e.g., bacterial endophthalmitis, toxic lens syndrome, pseudo-phakoanaphylactic endophthalmitis, and sympathetic ophthalmia is described.