endophthalmitis complications

[topcat172]

After cataract surgery I developed asevere case of strep endopthalmitis. I had a vitrectomy to resolve the infection. Since then I was diagnosed with acute closed angle glaucoma. I  had 2  patent iridotomys but still have to use glaucoma drops. I still have only light perception as visual acuity. I had another vitrectomy last week to remove an epiretinal membrane and scartissue from the front of the eye. The retina specialist and i both hoped my vision would improve immediately but after the bandage was taken off, i still only have light perception. I now was told I have severe vitreous hemorrhaging in this eye. I was told to wait for one week and come back and would probably have to have another vitrectomy. My eye pressure is very high and was told it was due to the blood in the vitreous. Does vitreous hemorrhage increase the risk of retinal detachment? Also the retina specialist says he cannot see in the eye any better than I can see out, so we do not know if optic nerve has been damaged. Since pressure is incresing is it likely to do damage to optic nerve that we can't see? Since I can't see out of this eye, how will I know if retina does become detached? I meant to ask these questions at my appointment but I always get bad news and forget until I get home. Thanks!!

[Michael J Kutryb, MD]

I'm am truly sorry about your complications.  You have been through so much - you must feel terrible.  Regarding a retinal detachment - if you can't see much - you may not be able to tell if you have a detachment.  Perhaps you might notice new flashes of light - but that would be about it.  Some red blood cells from the vitreous can sneak into the anterior chamber and clog the drainage system causing high pressure.  It can be very difficult to control.  Also sometimes patients get a gas bubble injection into the eye and that can cause the pressure to rise as well.  You know, I am a little puzzled about the blood in vitreous.  The vitrectomy is supposed to help make vision better and is often used to remove blood, not create more bleeding.  Something does not add up.  Why the bleeding?  What is the source?  Try to keep the eye pressure as good as possible and ride out this current problem and let blood settle down and then hopefully it can be something treatable with retinal laser and hopefully no more surgery needed.  I'm worried that you might need more surgery and that prognosis is still not very good.  God Bless You.

Michael J. Kutryb, MD

[Michael J Kutryb, MD]

The synechia are due to scar tissue gluing the IOL to the iris.  It could actully completely occlude the flow of aqueous humor from the ciliary body through the pupil (pupillary block) to the trabecular meshwork.  The iridotomy allows aqueous humor to bypass the pupil. This doesn't cure glaucoma because your trabecular meshwork is still probably very cloggged and damaged.  You may still need a filtering procedure or a shunt to bypass the trabecular meshwork.  Synechia can sometimes dissolve with time and lots of steroids, which unfortunately can worsen the glaucoma.  Like I said before, nearly all systems are severely damaged and in intensive care.  The iridotomy will help buy you some time, but you are going to have to still make some major improvements overall.

MJK MD

[topcat172]

If i had the 2 iridotomys that opened my angles and relieved the pupillary block that was caused by peripheral anterior synechiae, Can the posterior synechiae that has now developed cause pupillary block? What is the difference between the two and how do you treat posterior synechiae? What effect does posterior synechiae have on the eye?
I am only 43 years old and was in the process of getting my Masters Degree when I had the cataract surgery that caused the infection that has led to all of these problems. Because of this I have not been able to return to school and this is very disturbing to me. I realize that you can't answer all of my questions but you have been so helpful and I want to express  my gratitude for your help and insight. Thanks so much!

[Michael J Kutryb, MD]

Obviously you are in very bad shape and the prognosis is not good.  With a bad case of endophthalmitis, essentially all the eye systems can be severely affected including corneal swelling, glaucoma, clouding of the vitreous and swelling of the retina.  The glaucoma could be the one issue that could cause total blindness if not controlled.  The steroid drops and injections, while they can help the macular edema, can also increase the eye pressure you are in a tough situation.  Stop them and vision gets worse perhaps, use them and pressure may be worse and vison gets worse.  How many surgeries can you have???   Maybe 3 or 4 or 5 - then you start to reach diminishing rewards.  I cannot recommend that you stop treatment because I don't know your case enough.  Much depends on the state of the other eye.   It sounds to me like you may need a glaucoma filtering or shunt operation before too long to prevent complete loss of vision.  Good Luck.  I'm sorry, but endophthalmitis has the potential to be this bad.  It is a very, very bad diagnosis.

Michael Kutryb, MD

[topcat172]

I hate to keep bothering you  but at my appointment yesterday the retina MD said vitreous hemorrhage was resolved but that I now have Cystoid Macular Edema and that everything that could go wrong was going wrong.. My eye pressure was 36 in my left eye which is the one I have had the most problems with but my right eye had pressure of 36 also. He seems to think that all of the problems with my eye go back to the endopthalmitis even though it has been resolved for some time. I now have to use the Trusopt and Alphagan in my right eye also. He told me to continue using prednisone drops and Xibrom. Is it normal for a case of endophthalmitis to cause all of these complications? I have asthma so I cannot use any Beta-Blockers because my primary care physician says I have an extreme sensitivity to them and when i was prescribed Cosopt by my regular ophthalmologist, I  had a severe asthma attack and had to have Decadron injections and oral prednisone for several weeks. The Retina MD says if the drops do not work, he wants to do an injection into my eye and pssibly a 3rd vitrectomy. How many times can an eye be operated on before you have to give up? Have you ever had a case with this many problems? I am wondering if I should just give up and refuse more treatment. I would appreciate your insight. Again, I am sorry to keep bothering you but have found your input very helpful. Thanks so much!

[Michael J Kutryb, MD]

Yes, throwing up could definitely cause more bleeding and at least shake up the blood that is trying to settle down.  I'm sorry for your ongoing saga.  You must be a very strong individual to make through all of this.

Michael Kutryb, MD

[topcat172]

Thanks for your answer to my questions and for your kind words. I found out bleeding was coming from fundus of eye whatever that means. At last appointment  hemorrhage was decreasing and I had small return of vision. I could see outlines, vision is still gray and dark. Now I have a central darker hole in vision and outlines I could see are now wavy and I now see numerous long strands of floaters. Retina Specialist was called today and wants me to come in  a week earlier than previously scheduled. Is it possible vitreous hemorrhage has gotten worse and would that cause the hole in vision, wavy lines, and long, stringy floaters? I have had a stomach virus. Could throwing up cause eye to hemorrhage? Thanks again for your help and kind words.