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JAMA Ophthalmology Clinical Challenge
April 2018

Chronic Inflammation After YAG Capsulotomy

Author Affiliations
  • 1Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina
JAMA Ophthalmol. 2018;136(4):444-445. doi:10.1001/jamaophthalmol.2017.4372

A 65-year-old man was referred for evaluation of uveitis in the left eye. Several days after YAG capsulotomy for posterior capsule opacification, his left eye had become red and painful and his visual acuity had declined to counting fingers. Inflammation improved but persisted after vitreous tap and injection of intravitreal vancomycin hydrochloride (1.0 mg) and ceftazidime (2.25 mg) followed by intravitreal triamcinolone acetonide. Vitreous cultures yielded no growth.

Six months after the patient’s symptoms began, he presented to our clinic. His visual acuity was 20/20 OD and 20/160 OS improving to 20/120 OS with pinhole. His intraocular pressure was 32 mm Hg OD and 20 mm Hg OS. The results of ophthalmic examination of the left eye were notable for pigmented keratic precipitates, a rare anterior chamber cell, 2+ (ie, 16-25 cells per field) anterior vitreous cells, epiretinal membrane, and cystoid macular edema. Tuberculosis, sarcoidosis, syphilis, and HLA-B27 laboratory test results were negative. The macular edema improved with 4 times daily topical prednisolone acetate and ketorolac tromethamine.