Bilateral endophthalmitis after cataract surgery causing scleral melt and intraocular lens exposure

Introduction: Postsurgical endophthalmitis is a rare but serious complication most commonly occurring after cataract surgery. As immediately sequential bilateral cataract surgery (ISBCS) becomes more used, it is important to recognize the risk for bilateral endophthalmitis leading to permanent vision loss. This report reviews a devastating complication of ISBCS. Patient and Clinical Findings: We report a 64-year-old man who underwent ISBCS, who presented with severe headache and eye pain late in the course of bilateral endophthalmitis. The right eye was disorganized with shrinkage in addition to superior scleral rupture/melt and prolapsed uveal tissue. The left eye showed superior complete scleral thinning with an exposed intraocular lens. Diagnosis, Intervention, and Outcomes: Computed tomography maxillofacial study confirmed bilateral endophthalmitis with deformation of the globes with abscess formation. A culture of the exposed purulent material revealed multidrug-resistant Pseudomonas aeruginosa. Owing to the severity of the infection, a primary bilateral enucleation was performed, which was tolerated well without signs of systemic infection. Conclusions: Surgeons should proceed with caution, given the devastating complications that can come with ISBCS. Stricter criteria for patient selection may avoid complications when patient reliability or incomplete medical history is of concern.