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Endocapsular hematoma as an uncommon early postoperative complication of phacoemulsification with intraocular lens implantation surgery

Herein we describe a 55-year-old woman presented with a chief complaint of visual loss in the right eye of 3 days duration. The patient underwent uncomplicated phacoemulsification cataract surgery on the right eye 1 week ago. Slit lamp examination revealed accumulation of blood in the capsular bag behind the intraocular lens with blood level. The patient was diagnosed as endocapsular hematoma. Neodymium-doped: yttrium-aluminum-garnet laser posterior capsulotomy was performed. The patient's vision improved completely.

Endocapsular hematoma (ECH) is a rare intraocular hemorrhage in pseudophakic eyes. In this condition, blood accumulates in the capsular bag between the intraocular lens (IOL) and the posterior capsule. [1,2] Case Report A 55-year-old well-controlled diabetic female presented with a chief complaint of decreased vision in the right eye (RE) 3 days prior to presentation. She had no history of hypertension and the usage of antiplatelet and anticoagulant drugs. She underwent uncomplicated cataract surgery (phacoemulsification) of RE under topical anesthesia with clear corneal incisions, circular capsulorhexis, and IOL implantation in the bag 1 week ago. There was no bleeding or iris trauma during operation, but at the end of surgery due to leakage of the main incision, it was sutured using a 10/0 nylon figure-of-8 suture. One day after the surgery, RE examination revealed the best-corrected visual acuity (BCVA) of 20/32, intraocular pressure (IOP) of 9 mm/Hg (Goldmann tonometer). Slit-lamp examination showed clear This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.  cornea, formed anterior chamber (AC), and in the bag IOL. One week after the surgery, the patient referred to us with gradual painless loss of vision in her RE of 3 days duration. RE examination revealed BCVA of 20/400, IOP of 14 mm/Hg, and accumulation of blood in the capsular bag behind the IOL with a blood level [ Fig. 1a and b]. After 3 months of follow-up, there was no change in the BCVA, IOP, and ECH size. The neodymium-doped: yttrium-aluminum-garnet (Nd: YAG) laser posterior capsulotomy was performed [ Fig. 2a], and 1 week later, the BCVA improved to 20/25 [ Fig. 2b].

Discussion
The sources of blood in ECH might be iris vessels, AC angle, ciliary sulcus, and surgical wound. [1][2][3][4] It seems that, during the suturing of corneal incision, the blood of limbus vessels enters the AC, passes from the margin of anterior capsule, and fills the capsular bag. When there is a need for suturing of corneal wounds, it is recommended to perform AC irrigation and air bubble injection at the end of the surgery. Therapeutic options for the management of ECH include observation and Nd: YAG capsulotomy.
which was treated with systemic and intravitreal antibiotics, with control of infection.

Key words: Burkholderia cepacia, endogenous endophthalmitis, retinal abscess
Endogenous endophthalmitis is rare and accounts for approximately 2-15% of all cases of endophthalmitis [1] and occurs when infectious organisms are spread from distant focus to the eye through the blood stream. [2] In Asia, generally endogenous endophthalmitis is usually caused by Gram negative organism Klebsiella pneumonia (KP), whereas gram positive organisms and fungi are the common agents seen in North America and Europe. [3] Burkholderia cepacia is a gram negative, oxidase positive, non-fermenting bacillus. Ocular infections in the form of Keratitis and endophthalmitis due to this organism is rarely reported. It was isolated in 1.8% cases of culture positive cases of endophthalmitis. [4] We report the first case of endogenous endophthalmitis following B. cepacia infection.

Case Report
A 33-year-old male, presented with the complaints of blurring of vision in the right eye of 3 days duration. Initial examination revealed visual acuity of 10/200 with no further improvement in the right eye and 20/20 unaided in the left eye. Anterior segment examination showed fresh keratic precipitates, grade 1 cells and flare in the anterior chamber, cells and exudates in the vitreous in the right eye. Examination of the retina revealed multiple intraretinal haemorrhages and