Elderly woman presents with progressive vision decline in left eye

A 76-year-old woman presented to the New England Eye Center with a 3-month history of floaters and blurred vision in her left eye. Her medical history was significant for hypertension, hyperlipidemia, hypothyroidism and recent aortic valve replacement 1 month before onset of visual symptoms. Her ocular history was significant for bilateral cataract extraction with placement of posterior chamber IOLs 5 years before presentation.She was initially evaluated by an outside retina specialist, at which time visual acuity was 20/160 due to diffuse vitreous haze in the left eye. At the outside hospital, she underwent pars plana vitrectomy with intravitreal injection of amphotericin B, vancomycin, ceftazidime and dexamethasone. Vitreous biopsy was negative, and multiple peripheral blood cultures were without growth. The patient initially did well after surgery with subjective improvement in her vision and floaters. Within 1 month of surgery, however, the patient noted recurrent worsening of her vision with increased floaters. Her visual acuity had declined to 20/320, and she was noted to have worsening vitritis. A repeat pars plana vitrectomy was performed with intravitreal injection of amphotericin B, vancomycin, ceftazidime and dexamethasone. Vitreous biopsy was again negative. Vitritis and worsening vision recurred soon after the second vitrectomy, and she was referred to the retina service at the New England Eye Center for further evaluation and management.