Endophthalmitis caused by Acinetobacter calcoaceticus. A profile

PURPOSE: To report the clinical and microbiological profile of endophthalmitis caused by Acinetobacter calcoaceticus. METHODS: A retrospective study of case series of Acinetobacter calcoaceticus endophthalmitis. Outcome measures included ability to sterilise the eye, anatomical result (clear media and attached retina) and visual recovery (visual acuity > 6/60). RESULTS: Of the 20 cases studied, 10 were cases of postoperative endophthalmitis, 3 were posttraumatic, 6 were endogenous and one was bleb-related endophthalmitis. Specific features of interest observed were relative chronicity of presentation and absence of any obvious predisposing factor in endogenous endophthalmitis cases. All cases could be sterilised except one, which needed evisceration. Cases with postoperative endophthalmitis had better anatomical outcome (7/10 with attached retina and clear media) and visual outcome (4/10 regained vision > 6/18). Higher smear positivity was seen in vitreous samples (72.2%) compared to aqueous samples (37.5%). Culture positivity was higher from the vitreous cavity compared to aqueous. The organism was sensitive to ciprofloxacin in a high percentage (88.9%) of cases. CONCLUSIONS: Visual recovery in Acinetobacter calcoaceticus endophthalmitis is modest. Ciprofloxacin is the antibiotic of choice.     

Trauma-induced endophthalmitis caused by Acinetobacter anitratus.

A 56-year-old man sustained an intraocular injury by a piece of steel followed by endophthalmitis, which resolved after lensectomy, vitrectomy, and intravitreal injections of gentamicin. Acinetobacter anitratus was the organism responsible for the endophthalmitis. It is a Gram-negative polymorphic organism that can resemble several other pathogens and possesses unpredictable antibiotic susceptibility. A. anitratus is an important cause of nosocomial infection but has not previously been reported as a cause of endophthalmitis following trauma.     

Postoperative endophthalmitis caused by Sphingomonas paucimobilis

We present a case in which a new organism, Sphingomonas paucimobilis, caused endophthalmitis after phacoemulsification in a 73-year-old woman. The case shows a recurrent acute endophthalmitis with complete resolution only after vitrectomy. This organism has not been described as a cause of endophthalmitis and was resistant to initial medical management. We also describe an interaction between this organism and a co-infective organism that may account for the unusual clinical course.     

Postoperative endophthalmitis caused by Bacillus cereus and Chlamydia trachomatis

PURPOSE: To describe the clinical manifestations and outcomes in 4 patients with endophthalmitis caused by Bacillus cereus and Chlamydia trachomatis. SETTING: Department of Ophthalmology, Ankara Training and Research Hospital, Ankara, Turkey. METHODS: Four patients who had cataract extraction and intraocular lens implantation with phacoemulsification at a secondary eye-care center presented with endophthalmitis. Cultures and direct fluorescein assay (DFA) were performed on vitreous aspirates from all patients. RESULTS: Cultures were positive for B cereus and DFAs were positive for C trachomatis in all patients. Despite timely intervention, at the end of follow-up, 1 patient had 20/200 visual acuity and another, counting fingers at 3 m. Phthisis bulbi developed in the 2 other patients. CONCLUSION: The course of infection with B cereus and C trachomatis poses a potential threat, especially because of the limited data on treatment of endophthalmitis secondary to C trachomatis.     

Postoperative mycobacterial endophthalmitis

We treated two sporadic cases of postoperative endophthalmitis caused by rapidly growing (Runyon's group IV) mycobacteria. Both involved intraocular lenses, one a secondary implant after intracapsular cataract extraction (Mycobacterium chelonae subspecies abscessus) and the other a primary posterior chamber lens implantation after extracapsular cataract extraction (pigment-producing member group IV). Signs of inflammation were judged severe enough to warrant diagnostic and therapeutic intervention during the fourth postoperative week in both cases. In both eyes the organism seemed to be eradicated by intravitreal amikacin in combination with vitrectomy, as well as topical, subconjunctival, and, in one case, systemic antibiotic therapy.     

Postoperative endophthalmitis.

Postoperative endophthalmitis is a rare, albeit serious, complication of cataract surgery. Over the years, preoperative and operative measures, such as lid hygiene, appropriate surgical draping, and improved surgical technique, have all decreased the incidence of postoperative endophthalmitis. Commonly used prophylactic measures include preoperative topical, intracameral, and postoperative topical antibiotics. Since the landmark study done by the endophthalmitis vitrectomy study group, treatment has usually consisted of intravitreal antibiotics with or without pars plana vitrectomy (depending on the patient population). In this review, we have focused on advances in the field of endophthalmitis within the last year. These include articles examining treatment and complications of diabetic patients and those with retinal detachments, bacterial adherence to lenses, prophylactic measures, and addition of steroids to conventional treatments of endophthalmitis.     

Postoperative endophthalmitis.

Endophthalmitis has typically been described as occurring within the first 24-48 hours postoperatively and having a rapid progression. Classical signs and symptoms include intense ocular pain, decreased visual acuity, and exaggerated inflammatory response not commensurate with the level of the patient's recuperative process. This article presents a case wherein a patient, following cataract surgery and implant, developed endophthalmitis of a more indolent nature with a later onset of symptomatology and associated sequelae. Reasons this delayed onset of symptoms may occur are discussed. Etiological considerations, current treatment modalities, and management protocol are reviewed.     

Postoperative low-grade endophthalmitis caused by biofilm-producing coccus bacteria attached to posterior surface of intraocular lens

We report a case of low-grade inflammation that developed in the anterior segment after cataract extraction with intraocular lens (IOL) implantation. The 57-year-old patient complained of blurred vision 2 weeks after phacoemulsification and IOL implantation in the right eye. Slitlamp biomicroscopy showed many nonpigmented keratoprecipitates. After antibiotic therapy failed, the IOL was removed and aqueous collected. Scanning electron microscopy of the IOL demonstrated many biofilm-producing cocci with slime on the IOL, and aqueous smears showed gram-positive cocci. Two weeks after removal of the IOL, the inflammation disappeared.