Acute postoperative endophthalmitis by Gemella haemolysans

Endophthalmitis is a rare and serious post-surgical complication. We report a case of acute postoperative endophthalmitis after an uneventful cataract surgery caused by a commensal organism, Gemella haemolysans. The patient was successfully treated with vitrectomy and intravitreal antibiotics like vancomycin, along with topical cefazolin.     

A case of Pantoea endophthalmitis

A previously healthy 50-year-old man was transferred to our hospital for evaluation of acute inflammation in his right eye after ocular trauma while using a grass mower. Slit lamp examination showed 1 mm-length full thickness corneal laceration without leakage, 4+ cells and inflammatory membrane in the anterior chamber, 10% hypopyon, posterior synechiae formation, and cataract change. Upon orbital computerized tomography, a metallic intraocular foreign body in the lens was identified. Vitrectomy, phacoemulsification, foreign body removal, anterior chamber irrigation, and intravitreal antibiotics injections of vancomycin and ceftazidime were performed. In a culture of humor from the anterior chamber grew Pantoea species. More procedures were performed, including intravitreal antibiotics injection of ceftazidime. Upon administering a course of intravenous ceftazidime, fortified ceftazidime and moxifloxacin eye drops, and oral prednisolone, the patient improved.     

A case of postoperative Sphingomonas paucimobilis endophthalmitis after cataract extraction

PURPOSE: To report a case of an acute onset of delayed postoperative endophthalmitis that was caused by Sphingomonas paucimobilis. METHODS: This case demonstrates an acute onset of delayed postoperative endophthalmitis at 3 months after uneventful cataract extraction and posterior chamber intraocular lens implantation. We performed vitrectomy, intraocular lens and capsular bag removal, and intravitreal antibiotics injection. On the smear stains from the aspirated vitreous humor, gram-negative bacilli were detected and S. paucimobilis was found in culture. RESULTS: At three months after vitrectomy, the best corrected visual acuity was 20/300. Fundus examination showed mild pale color of optic disc and macular degeneration. CONCLUSIONS: Vitrectomy with intravitreal ceftazidime injection had contributed to the favorable result in case of an acute onset of delayed postoperatire endophthalmitis caused by S. paucimobilis.     

金黄色葡萄球菌和大肠埃希杆菌混合感染性兔眼内炎模型的建立

目的 建立外源性金黄色葡萄球菌和大肠埃希杆菌混合细菌性眼内炎动物模型，为进一步开发治疗复杂性眼内炎的新型药物打基础。 方法 新西兰白兔42只84眼，随机分组为混合细菌组、金黄色葡萄球菌组和大肠埃希杆菌组等3个实验和1个生理盐水对照组，每组21眼。实验组分别玻璃体腔注射0.1 ml的2×104 CFU/ ml的混合细菌悬液（含金黄色葡萄球菌和大肠埃希杆菌各103）、104 CFU/ ml的金黄色葡萄球菌悬液和104 CFU/ml大肠埃希杆菌悬液，对照组注射0.1ml无菌生理盐水。分别于注射后6、12、24、48、72 h和7 、14 d行裂隙灯显微镜、检眼镜、眼部A/B超和视网膜电图（ERG）检查；同时各眼抽取玻璃体液0.1 ml做细菌鉴定和计数，后剖取眼球做组织病理学观察。 结果 临床观察发现，3个实验组注射后均有不同程度的炎症反应，而总变化趋势趋于一致，混合细菌组在注射后12 h出现明显的前房渗出等炎症反应，较金黄色葡萄球菌组和大肠埃希杆菌组早，48 h～72 h最重，4～7 d炎症反应开始缓慢减轻，10～14 d炎症明显减轻，角膜出现新生血管，玻璃体呈灰白色混浊。细菌培养发现，混合细菌组6 h～14 d阳性率为100%；金黄色葡萄球菌组6～72 h阳性率为100%，7～14 d阳性率为0；大肠埃希杆菌组6 h～7 d阳性率为100%，14 d阳性率为67.67%；对照组6 h～14 d阳性率为0。ERG检查，注射后各实验组在48 h后b波波幅均消失，生理盐水组ERG-b波波幅下降小于30%。病理学检查，注射后各实验组表现为眼内各组织的炎细胞浸润。 结论 通过兔眼玻璃体腔注射金黄色葡萄球菌和大肠埃希杆菌的方法成功建立了稳定的混合细菌所致的复杂性眼内炎模型。     

Late-onset Citrobacter koseri endophthalmitis with suture exposure after secondary intraocular lens implantation

A 54-year-old male patient was seen in clinic for ocular pain and decreased vision in the right eye with duration of two days. He underwent a cataract operation for his right eye 12 years ago, then a sclera-fixated secondary intraocular implantation and pars plana vitrectomy three years ago due to intraocular lens dislocation. At the initial visit, his visual acuity was restricted to the perception of hand motion. An edematous cornea, cells, flare with hypopyon, and exposed suture material at were observed at the six o'clock direction by slit lamp. Vitreous opacity was noted from B-scan ultrasonography. The patient was diagnosed with late-onset endophthalmitis and an intravitreal cocktail injection was done. On the next day, the hypopyon was aggravated, and therefore a pars plana vitrectomy was performed. A vitreous culture tested positive for Citrobacter koseri. After 12 weeks, the best corrected visual acuity of the right eye improved to 0.7 and a fundus examination revealed a relatively normal optic disc and retinal vasculature. We herein report the first case of endophthalmitis caused by Citrobacter koseri in Korea. Exposed suture material was suspected as the source of infection in this case and prompt surgical intervention resulted in a relatively good visual outcome.     

Traumatic endophthalmitis presenting as isolated retinal vasculitis and white-centered hemorrhages: Case report and review of literature

The article reports a case and review of the literature of endophthalmitis presenting as isolated retinal vasculitis. A 26-year-old male was observed to have white-centered retinal hemorrhages and retinal vasculitis following an occult scleral perforation. At presentation, the visual acuity was 20/60. With clinical suspicion of early endophthalmitis, he underwent wound exploration, scleral tear repair, vitreous biopsy and administration of intravitreal antibiotics. Microbiology evaluation revealed significant presence of methicillin-resistant coagulase-negative Staphylococcus epidermidis. Final visual acuity improved to 20/20 at 6 weeks postoperatively. Literature search revealed eight similar cases, all of them due to Staphylococcus species. Retinal vasculitis and white-centered retinal hemorrhages can be a presenting sign of early endophthalmitis, especially with non-fulminant pathogens like S. epidermidis.     

Acute bacterial endophthalmitis after intravitreal bevacizumab injection: Case report and literature review

A case report of a 52 year old male who received intravitreal bevacizumab and developed culture positive endophthalmitis. Vitreous culture indicated that endophthalmitis was caused by Staphylococcus epidermidis. The patient was initially managed with intravitreal injection of ceftazidime and vancomycin, followed by pars plana lensectomy, pars plana vitrectomy with intravitreal injection of 1 mg/0.1 ml vancomycin, 2.25 mg/0.1 ml ceftazidime, 5 mg/0.1 ml fortified amphotericin-B and 4 mg/0.1 ml dexamethasone. Postoperatively the patient improved significantly. However, vision improved from hand motion to counting fingers secondary to severe retinal ischemia. Acute endophthalmitis can develop after intravitreal bevacizumab injections and cause profound visual loss. A review of literature was also performed for similar cases.     

A Case of Bilateral Endogenous Pantoea Agglomerans Endophthalmitis with Interstitial Lung Disease

We here in report a case of bilateral endogenous endophthalmitis caused by Pantoea agglomerans (P. agglomerans) in a patient who had interstitial lung disease and was treated with oral corticosteroids. A 72-year-old man presented with decreased visual acuity in both eyes nine days after he received oral corticosteroids. He had marked uveitis, cataracts, and vitreous opacities. Cultures were taken of blood, aqueous humor, and vitreous. We initially suspected a fungal etiology and treated him with antifungal drugs; however, the intraocular disease progressed without improvement. Vitreous culture was positive for P. agglomerans. The patient underwent pars plana vitrectomy with cataract surgery bilaterally, followed by a 2-week course of antibiotics. The final visual acuity was 20/25 in the right eye and 20/200 in the left eye. This is the first report of bilateral endogenous endophthalmitis caused by P. agglomerans in Korea; it is also the first case reported outside of the United States.     

A case of endophthalmitis associated with limbal relaxing incision

Limbal relaxing incisions (LRIs) are considered a relatively safe procedure with rapid stabilization and absence of infectious complications. Do we need to readdress this last impression? We report a case of nocardia endophthalmitis associated with an exudate at the site of an LRI in a patient who underwent routine cataract surgery. This case, to the best of our knowledge, is the first report of its kind, stressing the need for a cautious approach to the adoption of this method of astigmatic correction.     

A case of endogenous bacterial endophthalmitis caused by <Emphasis Type="Italic">Streptococcus bovis</Emphasis>

Background Streptococcus bovis is a gram-positive streptococcus present as normal flora in the digestive tracts of herbivores. It is occasionally isolated from the human intestine and may act as a causative organism of infectious endocarditis, urinary infections and meningitis. This report describes a rare case of a patient that underwent surgical treatment for endogenous endophthalmitis caused by S. bovis complicated by bacteremia and suppurative spondylitis. Methods Endophthalmitis of the right eye occurred in a 76-year-old man accompanied by hypopyon and prominent vitreous opacity complicated by suppurative spondylitis. The visual acuity of the right eye consisted of light perception. Lensectomy and vitrectomy were performed immediately using a perfusate containing antibiotics. Antibiotics were administered by intravenous infusion following surgery. Results S. bovis was detected in the cultures of blood and vitreous fluid collected during surgery. The visual acuity was 20/160 at 11 months after surgery. Conclusions Reports of endogenous endophthalmitis in human caused by S. bovis have not been found to date in a search of the MEDLINE database. This is the first report of acute endogenous endophthalmitis caused by S. bovis.     

A case of acute postoperative keratitis after deep anterior lamellar keratoplasty by multidrug resistant Klebsiella

A healthy lady of 42 years underwent deep anterior lamellar keratoplasty for granular dystrophy. The very next day, it was complicated by development of infectious keratitis. The organism was identified as multidrug resistant Klebsiella pneumoniae. Donor corneal button may be implicated in the transmission of infection in an otherwise uneventful surgery and follow-up. Nosocomial infections are usually severe, rapidly progressive and difficult to treat. Finally, the lady had to undergo therapeutic penetrating keratoplasty for complete resolution of infection.     

Management of recurrent postoperative fungal endophthalmitis

Aim:

To report the management of recurrent postoperative fungal endophthalmitis (POFE) after failed pars plana vitrectomy (PPV) and antifungal therapy.

Settings and Design:

Tertiary Care Referral Centre in North India. Retrospective, single institution, interventional case-series.

Materials and Methods:

Six patients with microbiologically proven recurrent post-operative fungal endophthalmitis refractory to conventional management were included. The final recurrence was managed with intraocular lens (IOL) explantation and re-PPV. Main outcome measures included preserved globe anatomy, visual acuity and retinal status. ‘Anatomical success’ was defined as preserved anatomy of the globe, and absence of signs of inflammation. ‘Functional success’ was defined as an attached retina and a best corrected visual acuity of better than 20/400.

Results:

Of the six cases of POFE, five were culture positive [Aspergillus flavus (1), Aspergillus fumigatus (2), Candida albicans (1) and Candida glabrata (1)] and one was smear positive for yeast. All recurred (mean recurrences, 4) despite a mean of 2.17 PPVs and intravitreal amphotericin B. No recurrences were observed after IOL explantation with re – PPV (median follow-up, 37 months). Pre-study defined criteria for successful ‘anatomical’ and ‘functional’ outcomes were achieved in 83.3% and 50% respectively.

Conclusion:

This report highlights the effective role of combined IOL explantation with PPV in managing recurrent POFE.     

Aspergillus terreus endogenous endophthalmitis: Report of a case and review of literature

We report a rare case of Aspergillus terreus endogenous endophthalmitis in an immunocompetent patient with subretinal abscess and also review the reported cases. A 50-year-old healthy male presented with sudden painful loss of vision in right eye. He was diagnosed with endogenous endophthalmitis and underwent urgent vitrectomy. Aspergillus terreus growth was obtained in culture. At final follow-up, there was complete resolution of the infection but visual acuity was poor due to macular scar. Aspergillus terreus is a rare cause of endophthalmitis with usually poor outcomes. Newer antifungals like Voriconazole can be sometimes associated with better prognosis.     

Direct aspiration of capsular bag material in a case of sequestered endophthalmitis

Chronic recurrent endophthalmitis can occur following uncomplicated cataract surgery with intraocular lens implantation secondary to organisms sequestered in the capsular bag. There is a need to identify these sequestered organisms to facilitate appropriate management. Frequently, specimens from the anterior chamber and vitreous cavity could be unyielding, especially in the early cases in which the vitreous is still uninvolved. This article highlights the technique of directly sampling the capsular bag material in the effective diagnosis of the organism, which facilitates the total cure by irrigation with appropriate antibiotics into the capsular bag.     

Intravitreal dexamethasone as adjuvant in the treatment of postoperative endophthalmitis: a prospective randomized trial

Purpose To study whether intravitreal dexamethasone as adjuvant to intravitreal antibiotics improves the outcome in patients with suspected postoperative bacterial endophthalmitis. Design Prospective randomized clinical trial. Setting Tertiary referral center. Patient population Twenty-nine consecutive patients with suspected postoperative bacterial endophthalmitis within 6 weeks of cataract surgery. Intervention Patients underwent a vitreous biopsy followed by intravitreal injection of antibiotics (0.2 mg vancomycin and 0.05 mg gentamicin) and 400 μg dexamethasone or placebo. After 3–4 days the intravitreal injection of antibiotics and dexamethasone or placebo was repeated Primary outcome measure Snellen visual acuity at 3 and 12 months after treatment. Results In 20/29 patients (69%) the vitreous cultures were positive. 13/29 patients received dexamethasone. Seven patients had a functionally lost eye (final vision of hand movements or less), in four due to retinal detachment. Visual acuity tended to be better in the dexamethasone treated patients than in those given placebo, at both 3 months (P=0.055) and 12 months (P=0.080). Conclusion This small prospective, placebo-controlled series showed a trend towards a better visual outcome in patients with suspected bacterial endophthalmitis when treatment with intravitreal antibiotics was combined with intravitreal dexamethasone. Our findings justify a larger multicenter randomized study.     

Infestation of the lacrimal sac by Rhinosporidium seeberi: A clinicopathological case report

Rhinosporidium seeberi, till recently known as a fungus, has been reclassified as a protistan parasite. It infects humans and many animal species. The authors describe a rare case of oculosporidiosis with involvement of the lacrimal sac exhibiting features of idiopathic orbital inflammatory disease in a young male patient. Clinical features, pathophysiology, and management of lacrimal sac rhinosporidiosis have been discussed.     

玻璃体切除治疗真菌性眼内炎的临床分析

目的 评价玻璃体切除术治疗真菌性眼内炎的结果。方法 回顾性分析8例真菌性眼内炎的临床特点、诊断及手术治疗的效果。结果 8例真菌性眼内炎中，外源性感染3例、内源性感染5例，症状及体征不甚典型，初诊确诊率仅25％(2／8)，易误诊为细菌性眼内炎或葡萄膜炎。治疗效果差，有效率仅25％(2／8)，眼球摘除率达37、5％(3／8)．疗效与是否及时手术有关。结论 细菌性眼内炎、葡萄膜炎经正规的抗生素和皮质类固醇治疗无效者，应考虑真菌感染的可能，及早行玻璃优柚溶涂片和培养以明确诊断，及时进行玻璃体切除术及应用抗真菌药物。     

Pseudomonas aeruginosa endophthalmitis masquerading as chronic uveitis

A 65-year-old male presented with decreased vision in the left eye of 15-day duration after having undergone an uneventful cataract surgery 10 months back. He had been previously treated with systemic steroids for recurrent uveitis postoperatively on three occasions in the same eye. B-scan ultrasonography showed multiple clumplike echoes suggestive of vitreous inflammation. Aqueous tap revealed Pseudomonas aeruginosa sensitive to ciprofloxacin. The patient was treated with intravitreal ciprofloxacin and vancomycin along with systemic ciprofloxacin with good clinical response. Even a virulent organism such as P.aeruginosa can present as a chronic uveitis, which, if missed, can lead to a delay in accurate diagnosis and appropriate management.     

A rare case of subconjunctival dirofilariasis by Dirofilaria repens in rural Gujarat

Dirofilariasis is a worldwide zoonotic filariasis with over 782 cases reported so far from different parts of the world. Human dirofilariasis, caused by Dirofilaria repens, have been reported to occur widely throughout Asia, Europe, and Africa. It has not been widely recognized in India, however; several cases have been reported in last few years. There is probably a focus of human infection with D. repens in Kerala. Herein, we present a review of human infections by D. repens, along with a case report of subconjunctival dirofilariasis from rural part of Gujarat.