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CASE REPORT  
Year : 2020  |  Volume : 30  |  Issue : 1  |  Page : 92-94
Traumatic intralenticular abscess—What is so different?


1 Consultant Uvea Services, Aravind Eye Hospital, Pondicherry, India
2 Cornea Fellow, Aravind Eye Hospital, Pondicherry, India
3 Pediatric Fellow, Aravind Eye Hospital, Pondicherry, India
4 Consultant Cataract and IOL Services, Aravind Eye Hospital, Pondicherry, India
5 Consultant, Cornea and Refractive Services, Aravind Eye Hospital, Pondicherry, India

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Date of Submission09-Sep-2019
Date of Acceptance26-Nov-2019
Date of Web Publication30-Mar-2020
 

   Abstract 


Intralenticular abscess is a very rare entity that occurs after trauma, cataract surgeries, or as metastatic infection. It is important to pinpoint this sequestrated infection and to evacuate the abscess surgically to prevent chronic endophthalmitis. In this report, we describe a case of posttraumatic lenticular abscess highlighting the characteristic clinical features and their management. Additionally, here we report the first time use of Anterior Segment Optical Coherence Tomography as a diagnostic tool in delineating lens abscess from traumatic cataract which further guide the management and prognosis of the case.
Traumatic intralenticular abscess (TILA)—What is so different?

Keywords: Anterior segment optical coherence tomography; B scan; intralenticular abscess; moraxella, trauma

How to cite this article:
Balamurugan S, Gurnani B, Kaur K, Gireesh P, Narayana S. Traumatic intralenticular abscess—What is so different?. Indian J Radiol Imaging 2020;30:92-4

How to cite this URL:
Balamurugan S, Gurnani B, Kaur K, Gireesh P, Narayana S. Traumatic intralenticular abscess—What is so different?. Indian J Radiol Imaging [serial online] 2020 [cited 2020 Jun 5];30:92-4. Available from: http://www.ijri.org/text.asp?2020/30/1/92/281574



   Introduction Top


Intralenticular abscess is an uncommon condition that has been described after penetrating trauma, metastatic spread, and intraocular surgery.[1] It is a known fact that the lens is damaged in around 30% of perforating injuries of the eye and 10% of all intraocular foreign bodies lodge in the lens and in many of these cases the lens is retained.[1] There are very few reports of intralenticular abscess in the ophthalmic literature and none of the previous described literature has ever used imaging tool Anterior Segment Optical Coherence Tomography (ASOCT) for description of lenticular abscess.


   Case Report Top


A 65-year-old gentleman presented with right eye defective vision of 1 month duration following thorn injury. At presentation, visual acuity was hand movements close to face and intraocular pressure was 16 mmHg in right eye. Anterior segment examination revealed healed lamellar corneal tear, 1+ cells and heterogenous opacity of the crystalline lens [Figure 1]. Fundoscopy revealed hazy view. B scan ultrasound revealed no features suggestive of endophthalmitis [Figure 2]. ASOCT showed a heterogenous lenticular opacity suggestive of lens abscess [Figure 3]. Lens extraction was done by manual small incision cataract surgery (MSICS). Primary intraocular lens (IOL) implantation was deferred. Intracameral antibiotic wash was done. Culture of lenticular matter yielded  Moraxella More Details species. At 3 months, secondary IOL implantation was done as a staged procedure. The visual acuity at last follow-up was 20/40 at 15 months [Figure 4].
Figure 1: Image of right eye showing pinpoint corneal lamellar laceration with heterogenous lenticular opacity suggestive of lens abscess

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Figure 2: B Scan image of the right eye showing clear vitreous cavity with no signs of Endophthalmitis

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Figure 3: Image of Anterior Segment Optical Coherence Tomography of right eye showing heterogenous lenticular opacity suggestive of lens abscess

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Figure 4: Postoperative image of the same eye showing stable posterior chamber intraocular lens and quite eye

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   Discussion Top


ILA may camouflage a complicated cataract. Microbes can reach in by penetrating trauma (externally), metastatic infection (internally), or can be sterile.[1] Transition to endophthalmitis is possible and merits close monitoring.[2] It is important to recognize this sequestrated infection and evacuate the abscess surgically to prevent chronic endophthalmitis. Thorough literature review on lens abscess revealed application of extracapsular cataract extraction but ASOCT was not appropriately used.[3] It is highly relevant in assessing the integrity of posterior lens capsule (PC) and delineating the lens abscess. For an astute clinician, the chances of endopthalmitis increases multifold when PC is breached and warrants treatment along those lines. Discerning lens abscess from traumatic cataract is vital as primary IOL implantation is contraindicated. Secondary IOL as a staged procedure is needed to prevent smoldering infections. Early intervention, eradication of microbial load, and meticulous follow-up are the key elements of treatment success. In suspected fungal cases, intravitreal steroids are meticulously avoided. A high index of suspicion to look for secondary sequelae like secondary glaucoma, cystoid macular edema merits attention.[4],[5]


   Conclusion Top


In summary, to the best of our knowledge this is the first report of application of ASOCT as a diagnostic tool for delineating the lenticular abscess from traumatic cataract. In all cases with trauma, early removal of lenticular abscess is necessary to save the eye and prevent further complications. In our experience with this patient, staged surgical procedures helped in resolution of infection and attain an excellent final visual outcome.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Rajaraman R, Lalitha P, Raghavan A, Palanisamy M, Prajna NV. Traumatic lenticular abscess: Clinical description and outcome. Am J Ophthalmol 2007;144:144-6.  Back to cited text no. 1
    
2.
Salman A, Parmar P, Philip VR, Thomas PA, Jesudasan CA. Traumatic intralenticular abscess: A case series. Clin Exp Ophthalmol 2007;35:252-5.  Back to cited text no. 2
    
3.
Manners RM, Canning CR. Posterior lens abscess due to Propionibacterium acnes and Staphylococcus epidermidis following extracapsular cataract extraction. Br J Ophthalmol 1991;75:710-2.  Back to cited text no. 3
    
4.
Moore DC. Intralenticular abscess. Aust NZ J Ophthalmol 1989;17:313-5.  Back to cited text no. 4
    
5.
Hutchinson K, Kempster R, Conrad D. Intralenticular abscess caused by Stenotrophomonas maltophilia. Eye 2001;15:349-50.  Back to cited text no. 5
    

Top
Correspondence Address:
Dr. Bharat Gurnani
Department of Ophthalmology, Cornea Fellow, Aravind Eye Hospital, Pondicherry - 605 007
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijri.IJRI_369_19

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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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    Abstract
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   Case Report
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