PRESENTING AUTHOR

This report describes a rare and unexpected observation of internal limiting membrane (ILM) detachment during vitrectomy in a patient with endophthalmitis.

A 56-year-old diabetic female with a history of recent bilateral intravitreal bevacizumab injections for diabetic macular edema (DME) was referred to our center with symptoms of severe vision loss, eye pain, redness and discharge in the left eye for 5 days. A vitreous tap and intravitreal vancomycin and amikacin had been given at the referring center. Visual acuity in the left eye was light perception and BSCAN ultrasound showed dense vitreous opacities, ocular wall thickening and a thick membrane over the posterior pole that could represent a retinal detachment. Diagnosis of endophthalmitis was confirmed, and the patient underwent phacoemulsification and intraocular lens insertion, pars plana vitrectomy, membrane peeling and intravitreal vancomycin and ceftazidime injection. During surgery, an anomalous membranous detachment was observed in the posterior pole, with inflammatory deposits underneath. The core vitreous was removed and Dual blue staining was performed. The membrane was carefully removed with forceps. Dual blue was injected again showing negative staining. Culture of the vitreous sample revealed no bacterial growth, and the membrane was sent for histopathology. Postoperative course showed resolution of the infectious process and visual improvement to 20/300 in the left eye.

Ultrasonographic findings in endophthalmitis could be misinterpreted due to the dense intraocular infiltrates, membrane formation, and difficulty in identifying intraocular structures. The observation of ILM detachment during endophthalmitis surgery is an unusual finding that was neither anticipated nor previously reported in the context of endophthalmitis and could reflect a novel pathological response to intraocular infection, which in this case, was assumed to be a retinal detachment on preoperative ultrasound. The ILM detachment might be secondary to severe inflammatory processes disrupting the ILM's adhesion. This case highlights the need for awareness of such atypical intraoperative findings, which may influence surgical approaches and management strategies.

The unexpected discovery of ILM detachment during vitrectomy for endophthalmitis underscores the complexity of intraocular infections and their surgical management. This case provides valuable insight into the potential for rare intraoperative complications and emphasizes the importance of comprehensive preoperative and intraoperative assessment to guide effective treatment.