# Bilateral acute intermediate uveitis following intrauterine Chitosan tamponade: a case series

## TL;DR

A case series reports six postpartum patients who developed eye inflammation after using chitosan tamponade, suggesting a possible link.

## Contribution

Identifies a novel potential side effect of chitosan tamponade in obstetric care: bilateral intermediate uveitis.

## Key findings

- Six patients developed bilateral intermediate uveitis within 48-72 hours of chitosan tamponade.
- Symptoms resolved with corticosteroid treatment, and no prior uveitis history was found.
- No alternative explanations were identified for the inflammation.

## Abstract

Postpartum hemorrhage is a leading cause of maternal morbidity and mortality, with intrauterine tamponade techniques increasingly employed in its management. Chitosan-based products, such as Celox®, have been introduced for their hemostatic properties. However, their potential systemic effects remain insufficiently understood. This case series describes six patients who developed acute bilateral intermediate uveitis shortly after receiving intrauterine Chitosan tamponade during obstetric care.

A retrospective review was conducted on six postpartum patients who developed acute bilateral intraocular inflammation following the use of intrauterine Chitosan tamponade. Clinical data, laboratory findings, and ophthalmological assessments were analyzed. All six women presented with bilateral anterior and posterior segment inflammation within 48 to 72 h after tamponade placement. Common ocular findings included limbal corneal infiltrates, anterior chamber cells, vitritis, and decreased visual acuity. Three patients also experienced non-ocular symptoms, including perichondritis and auditory disturbances. Comprehensive evaluations, including infectious and autoimmune workups, were unremarkable in all cases. None of the patients had a prior history of uveitis or known systemic inflammatory conditions. Prompt initiation of topical and systemic corticosteroids led to the resolution of inflammation and recovery of visual function in all individuals. The uniform timing, bilateral occurrence of inflammation, and lack of alternative explanations indicate a possible association with the use of the Chitosan-based tamponade. The underlying mechanism remains uncertain, but an immunologic or toxic reaction is suspected.

This case series highlights a possible association between intrauterine Chitosan tamponade and the onset of bilateral intermediate uveitis in postpartum patients. Although causality cannot be definitely established, the temporal clustering and consistent clinical presentation warrant caution and further investigation into the systemic immunogenic potential of Chitosan-based products.