Post-Operative Endophthalmitis following Routine Photorefractive Keratectomy.

Introduction: Endophthalmitis is an exceptionally rare but devastating complication following laser corneal refractive surgery.

Case presentation: We present a case of Pseudomonas aeruginosa endophthalmitis following routine myopic photorefractive keratectomy with mitomycin C application. The patient was referred to a tertiary ophthalmic service with severe post-operative infectious keratitis following initial management at another centre and was treated with intensive fortified antibiotics. The eye subsequently developed endophthalmitis with corneal perforation, necessitating urgent pars plan vitrectomy facilitated by a temporary keratoprosthesis and subsequent therapeutic penetrating keratoplasty. During anaesthetic induction, the patient developed anaphylaxis, most likely secondary to succinylcholine. Aggressive posterior positive pressure was encountered intra-operatively, resulting in spontaneous extrusion of the crystalline lens. We postulate that the posterior positive pressure was caused by several factors, including massive inflammation, and fluid shifts secondary to anaphylaxis and its associated management. The positive pressure was successfully managed and a keratoprosthesis was secured, allowing completion of vitrectomy and therapeutic penetrating keratoplasty. At 6-month follow-up, the vision remains at light perception.

Conclusion: Endophthalmitis is an exceptionally rare but devastating complication following laser corneal refractive surgery, and the use of mitomycin C might have contributed to the rapid progression observed in the current case. Our report also highlights that acute anaphylaxis and its management can lead to posterior positive pressure, and measures should be taken to reduce the potential impacts before intraocular surgery and full-thickness incisions are made.