Accidental intravitreal injection of a veterinary inactivated FMD vaccine resulting in noninfectious intraocular inflammation: a case report

Figures

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  FIGURE 1. Photography of the anterior segment and fundus of both eyes. (A,B) The anterior and posterior segments of the right eye were within normal limits. (C,D) In the left eye, conjunctival congestion and edema, with significant edema in the inferior conjunctiva. Mild corneal edema was present. The anterior chamber contained inflammatory cells (++), with a marked flare (+++). The lens cortex showed irregular opacification. Dense vitreous haze was observed, with abundant inflammatory cells (+++), and the retina could be faintly visualized in situ.

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  FIGURE 2. On bilateral B-scan ultrasonography at initial presentation, (A) demonstrated punctate low-level echoes within the vitreous cavity of the right eye, with no evident retinal abnormalities. (B–D) Revealed relatively dense punctate and flocculent low-level echoes and continuous membranous structures within the vitreous cavity of the left eye, with adhesions to the nasal peripheral ocular wall and patchy strong echoes detected adjacent to the globe wall; no definitive signs of retinal detachment were observed.

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  FIGURE 3. FFA and ICGA of the left eye revealed poor clarity of the refractive media, tortuous and dilated retinal veins with irregular caliber and segmental staining, diffuse leakage from retinal capillaries, indistinct optic disc margins with intense late-phase hyperfluorescence, reduced background fluorescence in the inferior peripheral retina, and obscured retinal architecture.

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  FIGURE 4. Intraoperatively, milky white droplets consistent with the injected agent were identified within the vitreous cavity, the inferotemporal peripheral retina, and the superior retina.

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  FIGURE 5. First postoperative FFA of the left eye: left eye silicone oil eye, left eye retinal photocoagulation postoperative; left eye retinal venous tortuosity, capillary dilation and leakage at the optic disc, and patchy atrophic scars corresponding to laser photocoagulation in the superotemporal and inferotemporal peripheral retina.

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  FIGURE 6. Second hospitalization with anterior segment and fundus photography of both eyes. (A,B) No abnormalities were detected in the right eye. (C,D) In the left eye, marked mixed conjunctival hyperemia (+++) was present, with gray-white dust-like keratic precipitates (+). The anterior chamber depth was within normal limits, with mild floating inflammatory material (+) and anterior chamber flare (+). The pupil was irregular, with a horizontal diameter of approximately 4 mm, and irregular posterior synechiae of the iris were observed. Opacification of the lens cortex and posterior capsule was evident. Silicone oil filling was visible within the vitreous cavity. The optic disc appeared normal in color with clear margins. Retinal veins were dilated and tortuous. The macular architecture was indistinct, and the foveal reflex was absent.

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  FIGURE 7. During the second hospitalization, bilateral B-scan ultrasonography showed punctate low-level vitreous echoes in the right eye without apparent retinal pathology (A). In the left eye, the posterior interface of silicone oil was identified in the supine position, while a small amount of true ocular wall echo was detected in the lateral position. Within the observable range, no clear evidence of retinal detachment was noted (B).

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  FIGURE 8. Second hospitalization with bilateral optical coherence tomography. (A) right eye, (B) left eye. That demonstrated largely preserved macular structural integrity in both eyes.

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  FIGURE 9. Third hospitalization with anterior segment and fundus photography of both eyes. (A,B) Examination revealed no abnormalities in the anterior or posterior segments of the right eye. (C,D) In the left eye, irregular posterior synechiae of the iris persisted, with opacification of the lens cortex and posterior capsule. Silicone oil remained present in the vitreous cavity. Fundus examination showed a normally colored optic disc with well-defined margins, mildly tortuous retinal veins, and absence of the foveal light reflex.

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  FIGURE 10. Third hospitalization for left eye FFA performed: despite suboptimal clarity of the refractive media, demonstrated indistinct optic disc margins, capillary dilation with leakage, tortuous and dilated retinal veins with irregular caliber and segmental vessel wall staining, scattered patchy atrophic scars corresponding to prior laser photocoagulation in the peripheral retina, capillary leakage in the macular region, and intense late-phase hyperfluorescence of the optic disc.

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  FIGURE 11. Fundus after silicone oil extraction in the left eye showed: a clear optic disc margin with a pale pink coloration, largely normal retinal vascular configuration and proportions, and residual old laser photocoagulation scars. The foveal reflex remained absent.