A 70-year-old undergoes uneventful phacoemulsification; 3 weeks postoperatively he presents with pain, photophobia, and hypopyon. Slit-lamp shows a diffuse anterior chamber reaction with white fluffy material on the posterior capsule and IOL. Cultures are pending. The MOST likely diagnosis is:

• A Toxic anterior segment syndrome (TASS)
• B Phacoanaphylactic endophthalmitis
• C Lens-induced uveitis
• D Propionibacterium acnes (Cutibacterium acnes) delayed endophthalmitis ✓

Explanation

Cutibacterium (formerly Propionibacterium) acnes is a slow-growing anaerobe responsible for delayed-onset post-cataract endophthalmitis, typically presenting weeks to months after surgery with low-grade inflammation, white plaque or fluffy material on the posterior capsule (organisms sequestered in capsular bag), and anterior chamber reaction. TASS occurs within 24–48 hours, is non-infectious, and responds to steroids. Phacoanaphylaxis presents with granulomatous keratic precipitates after lens material exposure.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.