A 70-year-old man presents with deterioration of vision 3 weeks after cataract extraction and IOL implantation. Slit lamp examination shows honeycomb maculopathy and Fluorescin angiography (FA) shows ‘flower petal’ hyperfluorescence. The most likely diagnosis is:
First, I need to recall the possible post-cataract complications. Common ones include endophthalmitis, retinal detachment, posterior capsule opacification, and uveitis. But the mention of honeycomb and flower petal signs makes me think of something more specific.
Honeycomb maculopathy sounds like a pattern of retinal changes. Flower petal hyperfluorescence in FA is classic for a certain type of uveitis. Wait, there's a condition called acute anterior uveitis, but that's more about cells and flare in the anterior chamber. Then there's posterior uveitis, which could involve the macula.
Wait, the honeycomb appearance is characteristic of a specific type of maculopathy. I remember that sympathetic ophthalmia can present with a "honeycomb" or "candle wax" appearance of the retina. But that's usually after penetrating trauma, not just cataract surgery. Hmm.
Alternatively, there's a condition called punctate inner choroidopathy (PIC), which is a form of posterior uveitis. The hallmark of PIC is multiple small yellow-white lesions in the posterior pole, and FA shows early hyperfluorescence that may look like flower petals. The honeycomb maculopathy might be due to the inflammatory changes from PIC.
Another possibility is birdshot chorioretinopathy, but that typically has a more chronic course and different FA findings. Cytomegalovirus retinitis is a possibility in immunocompromised patients, but the time frame here is three weeks post-op, and the presentation is more acute.
Wait, the key here is the timing. Three weeks post-surgery, and the signs point to a posterior uveitis. The most likely diagnosis here is punctate inner choroidopathy. Let me verify the FA findings again. Flower petal hyperfluorescence is indeed a feature of PIC. The honeycomb maculopathy could be due to the inflammatory process affecting the retinal pigment epithelium and choroid.
So the correct answer should be punctate inner choroidopathy. The other options like sympathetic ophthalmia, birdshot, or CMV retinitis don't fit the presentation as well. Endophthalmitis usually presents with more acute symptoms and different signs like hypopyon. Retinal detachment might cause visual loss but wouldn't have the FA findings described here.
Therefore, the answer is Punctate Inner Choroidopathy (PIC).
**Core Concept**
This question assesses post-cataract surgery complications involving the posterior segment, focusing on characteristic fundus and fluorescein angiography (FA) findings. The key is recognizing uveitis subtypes based on imaging and clinical patterns.
**Why the Correct Answer is Right**
The "honeycomb maculopathy" and "flower petal" FA hyperfluorescence are hallmark findings in **punctate inner choroidopathy (PIC)**, a form of posterior uveitis. PIC typically presents 2–3 weeks post-cataract surgery