Acute bacterial endophthalmitis with focal vitritis at a nasal chandelier illumination port after scleral buckling.

BACKGROUND

Chandelier-assisted scleral buckling (CSB) has been reported to offer enhanced fundus visualization and reduced operative time during retinal detachment repair compared with conventional methods. However, the required intraocular penetration creates a potential route for bacterial entry into the eye.

CASE PRESENTATION: A 31-year-old man with high myopia presented with a rhegmatogenous retinal detachment involving the macula. He underwent urgent CSB using a 27-gauge chandelier positioned nasally at 5 o'clock. On postoperative day (POD) 10, a localized vitreous opacity appeared precisely at the insertion site. By POD 11, the opacity extended into the inferior vitreous cavity, consistent with acute postoperative endophthalmitis. Despite empirical intravitreal injections of vancomycin and ceftazidime with intensive topical moxifloxacin, the patient developed photophobia, ocular pain, and worsening vitritis on POD 12. An urgent lens-sparing pars plana vitrectomy was performed, and vitreous fluid cultures identified Staphylococcus epidermidis. Postoperatively, the inflammation subsided, and at 3 months, full retinal attachment was observed with a visual acuity of 20/16.

CONCLUSION

Whereas previously reported cases of CSB-related endophthalmitis typically presented with widespread intraocular inflammation obscuring the primary infectious focus, this case captures the early focal progression of vitritis in a chronological sequence. The localization at the nasal chandelier port provides visual clues to a possible entry route. The appearance of a localized vitreous opacity corresponding to a chandelier insertion site-even if subtle-should raise suspicion of acute endophthalmitis and prompt timely evaluation and treatment. The route and timing of bacterial entry cannot be established from this case alone.