Triamcinolone-assisted PPV was performed in a patient presenting with dislocation of a lens quadrant into the vitreous cavity with secondary macular oedema in her left eye (LO). Following phacofragmentation, a peeling of the internal limiting membrane revealed marked macular oedema. Due to this oedema, 5 mg/0.1 ml of triamcinolone acetonide (Trigon depot® Bristol-Myers Squibb SL, Anagni Frosinone, Italy) was injected at the end of the operation.
After a good immediate postoperative evolution, he came to the clinic four days later with painless visual acuity (VA) loss and a foreign body sensation in the LAA. VA was less than 0.05, with a 3.4 mm hypopyon formed by the deposition of fine crystalline opacities with no signs of inflammation, intraocular pressure of 10 mmHg and a well-positioned anterior chamber lens. The fundus showed marked vitreous haze.
The patient's clinical picture suggested infectious, toxic or pseudoendophthalmitis. Given the early onset, the absence of inflammatory signs except for the large pseudohypopyon, its crystalline nature and the fact that the patient had an anterior chamber lens that facilitated the diffusion of the triamcinolone, the symptoms were oriented towards pseudoendophthalmitis and it was decided to monitor her closely with ciprofloxacin eye drops every 2 hours (Oftacilox®, Alcon Cusi, El Masnou, Barcelona, Spain) and Poly-pred eye drops every 8 hours (Allergan, Wesport, Co. Mayo, Ireland). After four days, she was asymptomatic, with bullae in the corneal epithelium and a 4.3 mm hypopyon. As no improvement of the corneal epithelium was observed, a surgical cleaning of the anterior chamber with saline was performed after seven days. Three months later she was asymptomatic, her best corrected visual acuity was 0.3, and the cornea was clear with no traces of triamcinolone in the anterior chamber.