Atypical Endophthalmitis Following Artificial Corneal Endothelial Implantation

Purpose: EndoArt is an artificial endothelial layer device for the management of chronic corneal edema in cases with multiple corneal failed transplants, aiming to restore corneal deturgescence and optical clarity. However, postoperative complications, such as endophthalmitis, remain a significant risk. We report the first case of EndoArt-associated endophthalmitis, although a direct causual link remains uncertain. Case description: A 75-year-old woman presented with increasing floaters in the left eye 7 months after EndoArt implantation for corneal endothelial dysfunction following multiple graft failures. At presentation, the best-corrected visual acuity (BCVA) was counting fingers, without ocular pain. Slitlamp examination showed non-injected conjunctiva and well-positioned corneal implant with mild corneal edema. B-scan ultrasonography revealed mild vitreous haze, flat retina. Six weeks before, a corneal transfixing single suture was removed. Right eye was unremarkable. The following day, BCVA in the left eye worsened with the appearance of stromal infiltrate, anterior chamber fibrin, and hypopyon, increased vitreous opacification and vitreous strands, leading to diagnosis of endophthalmitis. The patient underwent prompt vitrectomy, revealing purulent vitreous infiltration and hemorrhagic chorioretinitis. The EndoArt was not removed, as not directly involved in the infection. Staphylococcus epidermidis was identified in the aqueous and vitreous humors. Postoperative local and systemic antibiotics led to a gradual resolution of inflammation. At 2-month follow-up, the BCVA improved to 20/400. Discussion: This case describes the atypical clinical appearance and the rapid progression of endophthalmitis in a patient with EndoArt. Prompt vitrectomy and a conservative approach, with EndoArt retention, led to infection resolution and preserved corneal clarity. Conclusions: Vigilance, early diagnosis, and a tailored surgical approach are crucial to improving outcomes after artificial corneal endothelial implantation. Here the artifcial corneal endothelium implantation may have helped preserve cornea clarity during endophthalmitis, enably timely vitrectomy and contribuiting to a favorable outcome.