brjopthal00143-0040

British Journal o f Ophthalmology, 1985, 6 9 , 836-840 Clinically unsuspected phacoanaphylaxis after extracapsular cataract extraction with intraocular lens implantation MARK S McMAHON, JAYNE S WEISS, KLAUS G RIEDEL, AND DANIEL M ALBERT From t h e David G Cogan E y e Pathology Laboratory o f t h e Massachusetts E y e and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA SUMMARY We describe t h e histopathological findings o f an enucleation specimen from a clinically undiagnosed case o f phacoanaphylaxis which occurred after extracapsular cata rac t extra ction with intraocular lens implantation. Phacoanaphylaxis, a granulomatous inflammatory response t o liberated lens protein, i s potentially curable b y prompt removal o residual lens material. This case emphasises that t h e diagnosis o f phacoanaphylactic endophthalmitis should b e considered i n any case o f extracapsular cataract extraction complicated b y granulomatous intraocular inflammation. I n 1919 Straub' d i scu s sed the possibility that liberated lenticular protein could incite uveitis. I n 1922 Verh oe ff and Lemoine2 introduced t h e term 'endophthalmitis phacoanaphylactica' f o r this lens- induced intraocular inflammation. Riise3 demon- strated that phacoanaphylaxis following extracapsular cataract extraction could b e dramatically arrested b y prompt removal o f residu al le ns material. We d es cr ib e th e histopathological findings o f a n enucleation specimen from a clinically undiagnosed case o f phacoanaphylaxis which occurred after extracapsular cataract extraction. This case emphasises that phacoanaphylactic endophthalmitis should b e suspected i n a n y e y e with persistent unexplained uveitis af ter extracapsular cataract extraction. Case report T h e patient w a s a n 80-year-old female who under- went extracapsular cataract extraction i n 19 83 with implantation o f a Simcoe anterior chamber lens. Five days postoperatively t h e patient h a d iris bombe, a n d laser iridotomy w a s performed t o relieve t h e pupil- lary block. T h e patient continued t o experience severe intraocular inflammation, suspected t o b e infectious endophthalmitis. This d i d n o t respond t o treatment, a n d t h e y e became increasingly painful, Correspondence t o Daniel M Albert, MD, Massachusetts E y e a n d Ea r Infirmary, 2 4 3 Charles Street, Boston, Massachusetts 02114, USA. with only light perception vision. S i x weeks after cataract extraction t h e e y e w a s enucleated. PATHOLOGICAL FINDINGS Gross examination revealed a shrunken, distorted e y e which measured 2 4 mm i n antero-posterior diameter. T h e sclera contained foci o f haemorrhage, t h e cornea w a s cloudy, a n d t h e iris w a s poorly visualised. On opening t h e e y e t h e vitreous w a s seen t o b e replaced b y a gelatinous, dark red-brown coagulum containing a 0 - 5 cm roughly oval grey- white mass involving t h e lens remnants (Fig. 1 ) . On microscopic examination t h e cornea w a s noted t o contain a well-healed full-thickness scar with chronic inflammatory cells, r e d blood cells, a n d extracellular pigment granules. T h e basal cell layer o f t h e epithelium w a s noted t o b e oedematous. Bowman s membrane w a s interrupted peripherally b y a fibrovascular pannus containing chronic matory cells. Descemet s membrane w a s frag- mented a t t h e site o f t h e cataract incision. Endothelial cells were decreased i n number a n d a retrocorneal membrane w a s present. T h e anterior chamber w a s shallow a n d contained chronic inflammatory cells, r e d blood cells, a n d pigment granules. T h e iris w a s infiltrated b y plasma cells, lymphocytes, a n d epithelioid cells. T h e iris w a s adherent peripherally t o t h e retrocorneal membrane, which cl osed the angle o n o n e side. Posteriorly t h e iris w a s adherent t o a n inflammatorymass which enveloped residual lens 8 3 6

brjopthal00143-0040

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