Acute-Onset Postoperative Herpetic Endophthalmitis: A Case Report

Area of Science:

• Ophthalmology
• Virology
• Infectious Diseases

Background:

• Herpes simplex virus (HSV) is a known cause of uveitis, but its role in acute postoperative endophthalmitis following cataract surgery is underreported.
• Postoperative endophthalmitis typically presents 2-7 days after surgery, with bacterial infections being the most common cause.

Observation:

• A 55-year-old male developed severe intraocular inflammation (grade 4+) with vitreous haze (grade 4) on postoperative day three after complicated cataract surgery.
• Initial vitreous samples were negative for bacterial and fungal infections, and treatment with intravitreal antibiotics was ineffective.
• Polymerase chain reaction (PCR) of ocular fluids confirmed the presence of herpes viral DNA.

Findings:

• This case presents a rare instance of acute-onset herpetic endophthalmitis occurring within 72 hours post-cataract surgery.
• The patient's condition significantly improved upon initiation of oral valacyclovir therapy, indicating a viral etiology.
• The absence of typical bacterial or fungal markers in diagnostic tests pointed towards a viral cause.

Implications:

• Ophthalmologists should consider herpetic endophthalmitis in the differential diagnosis of acute postoperative endophthalmitis, particularly when initial cultures are negative.
• Early suspicion and prompt antiviral treatment are essential for managing herpetic endophthalmitis and preventing vision loss.
• This case underscores the importance of considering viral causes, specifically HSV, in challenging postoperative endophthalmitis cases.