Objective grading of vitreous haze in endophthalmitis using ultra-wide field imaging

Endophthalmitis is defined as an inflammation of the inner coats of the eye, resulting from intraocular colonization of infectious agents with exudation within intraocular fluids.[1] Grading of the vitreous haze has a prognostic value in the course of the disease, and thus constitutes an important part of clinical examination in endophthalmitis. The Endophthalmitis Vitrectomy Study (EVS) standard of grading of vitreous haze has been accepted universally and is performed with an indirect ophthalmoscope.[2] However, this is a subjective method of grading the vitreous haze and may result in interpersonal variability. Earlier, Dickson et al. reported the efficacy of UWFI in detecting the presence or absence of vitreous haze, in the management of intermediate, posterior, and panuveitis.[3] However, quantification of vitreous haze was not undertaken by the authors. We extend the utility and propose an objective method of grading vitreous haze corresponding to EVS grading. We demonstrate this using sequential UWFI images obtained during the evolution from severe vitreous inflammation to complete recovery in a patient with early post-cataract surgery endophthalmitis treated using a standard approach [Fig. 1]. The patient was treated with three intravitreal injections of antibiotics at an interval of 2–3 days. Visual acuity improvement corresponding to improving media clarity was also observed during the course of follow-up over a period of 10 days. A summary of the UWFI observations and corresponding grading of the vitreous haze is shown in the table.Figure 1: UWFI of the left eye with grade 4- total obscuration of the view of the fundus; grade 3- the optic disc is hazily visible (yellow arrow); grade 2b- optic disc and second-order vessels in less than two quadrants are hazily visible (grade 2b, yellow arrow); grade 2a- optic disc and second-order vessels are visible in all the quadrants, with the posterior pole view obscured; and grade 1- the posterior pole is clear with residual peripheral haze temporally. UWFI = ultra-widefield imagingFinancial support and sponsorship: Nil. Conflicts of interest: There are no conflicts of interest.