Enterococcal endophthalmitis following cataract surgery

BACKGROUND: Postoperative endophthalmitis can be subdivided into acute and chronic forms which are typically caused by different organisms. Enterococcus faecalis is an organism which normally causes an acute form of endophthalmitis. PATIENTS AND METHODS: We report on four cases of different forms of endophthalmitis following cataract extraction and intraocular lens (IOL) implantation who had been referred to our institution between 1998 and 2001. Enterococcus faecalis was the causative organism in all of them. RESULTS: Two patients presented with an acute form and were immediately treated in our hospital after symptom onset utilizing pars plana vitrectomy with and without IOL explantation. The two other patients were initially treated with subconjunctival and/or systemic antibiotics and steroids over a period of about two months before referral to our hospital. After initial improvement the inflammation exacerbated in these two patients and vitrectomy with or without IOL and capsular bag explantation was performed. The explanted IOL and capsular bag of one patient were examined using scanning electron microscopy and it was shown that the enterococci were adherent to the IOL and the capsular bag. CONCLUSION:Enterococcus faecalis can be the causative organism both of an acute and of a recurrent form of postoperative endophthalmitis. The recurrent form may be caused by organisms which tend to adhere to the IOL and the capsular bag. This should be kept in mind when considering different treatment options.     

Micrococcal endophthalmitis following extracapsular cataract extraction with foldable silicone intraocular lens implantation

A case of postoperative endophthalmitis caused by micrococci, after phacoemulsification and foldable silicone intraocular lens (IOL) implantation is reported.     

Propionibacterium acnes endophthalmitis after intracapsular cataract extraction.

The authors report a case of Propionibacterium acnes endophthalmitis after intracapsular cataract extraction with implantation of an anterior chamber intraocular lens. The patient's chronic inflammation persisted for 5 years after cataract surgery despite treatment with pars plana vitrectomy, intraocular lens removal, topical and oral steroids, and topical fortified antibiotics. Fluctuations in the inflammation were paralleled by changes in the size and appearance of a white plaque on the posterior corneal surface. Anterior chamber tap cultures were positive for P. acnes after 8 days of incubation under anaerobic conditions. The inflammation was not controlled until the posterior corneal plaque, which was the presumed nidus of the chronic infection, was removed and the patient was treated with intravitreal and oral antibiotics.     

Acute bacterial endophthalmitis after cataract extraction

In order to evaluate the results, we reviewed all 34 patients treated in our hospital for endophthalmitis after cataract surgery between January 1994 and January 1998. After cultures were taken, all patients received intraocular, subconjunctival and topical vancomycin and ceftazidime. Additionally, twelve patients received the same antibiotics systemically. Besides steroids were administered in all patients. In 79% of the patients the bacterial culture was positive. Coagulase negative Staphylococcus was the most frequently isolated microorganism (48%). After treatment a visual acuity of 0.1 or more was achieved in 62% of the patients. The best final results were achieved in the patients with an initial visual acuity of 1/300 or more, and in the patients from whom a coagulase negative Staphylococcus was isolated.     

Histoplasma capsulatum endophthalmitis after cataract extraction

A 60-year-old white man from an area endemic for Histoplasma capsulatum presented with a vitreous wick, hypopyon iritis, and dense vitreitis 2 months after removal of an anterior chamber intraocular lens (IOL) for chronic iritis. A diagnostic vitrectomy was performed and H. capsulatum was cultured and identified 2 weeks later. Despite intravitreal and intravenous amphotericin as well as repeat vitrectomies, the inflammation worsened and the eye was removed. Results of histopathologic examination showed Histoplasma organisms along the vitreous wick, over the surface of the iris and ciliary body, and over the retina. No organisms were found in the choroid. Dalen-Fuchs-type nodules similar to those of sarcoid also were noted, but there was no evidence of granulomatous inflammation in the uvea. Because of his unilateral disease with Histoplasma in the vitreous wick, negative serology, and an absence of systemic infection, the authors believe that this patient had a previously unreported form of ocular Histoplasma, exogenous postoperative Histoplasma endophthalmitis.     

A cluster of patients with acute-onset endophthalmitis following cataract surgery.

BACKGROUND AND OBJECTIVE: To describe a cluster of patients who had acute-onset endophthalmitis following cataract surgery. PATIENTS AND METHODS: Ten patients with endophthalmitis following cataract surgery who were referred from three different anterior segment surgeons were evaluated. RESULTS: Presenting visual acuities ranged from 20/30 to light perception (median, 20/80). All 10 eyes demonstrated vitritis, 8 of 10 eyes had hypopyon, and the remaining 2 eyes had significant anterior segment fibrin. All patients were treated with intravitreal injections of vancomycin and ceftazidime, as well as subconjunctival steroids. Vitreous cultures were positive in 2 of 10 eyes, and both grew Staphylococcus epidermidis, aqueous cultures were negative in 8 of 8 eyes (not performed in 2 patients). Follow-up ranged from 13 to 85 days (median, 37 days). All eyes showed complete resolution of inflammation and visual acuity improved to 20/40 or better in 9 eyes (90%). CONCLUSIONS: Acute-onset endophthalmitis may occur in a cluster of patients within a short time frame. Early diagnosis and treatment may result in favorable visual outcomes.     

Capnocytophaga canimorsus endophthalmitis following cataract surgery

An elderly man developed endophthalmitis 1 week after cataract extraction and lens implantation. Intraocular samples were collected and the patient received intravitreal vanco-mycin and ceftazidime, and topical tobramycin. A Gram stain of vitreous humour revealed spindle-shaped Gram-negative bacilli. He was then given systemic clindamycin and topical ofloxacin. Capnocytophaga canimorsus, a member of the oral flora of dogs and cats, was cultured after 3 days. The infection resolved leaving the patient with a visual acuity of 6/60. An attempt was made to culture the organism from the mouth of the patient's pet dog. This was unsuccessful and the source of the infection remains unknown.     

Epithelial downgrowth following cataract extraction.

This case of epithelial downgrowth following cataract extraction shows the typical sequence of a noneventful cataract extraction with satisfactory recovery but after a time, the appearance of conjunctival injection, iritis and attacks of elevated ocular pressure. A minimal membrane on the posterior surface of the cornea could be seen but the diagnosis rested on the sequence of events and was confirmed by the pathologic investigation. The apithelial cells grow freely on the iris, but extend onto the cornea and posteriorly apparently without hindrance. The epithelial cells form a basement membrane next to the iris, much as they do on the surface of the cornea next to Bowman's membrane. The source of the cells in this case was not identified; they presumably came from conjunctiva although no track through the sclera was found and the cells themselves did not show goblet cells.     

Corneal astigmatism following cataract extraction.

The changes in corneal curvature in the first six months after cataract extraction were studied by performing sequential keratometry on a group of 57 patients. 8/0 Virgin silk interrupted sutures were used for the closure of corneoscleral incisions, and 10/0 monofilament tied in double running (bootlace) or single running (continuous) fashion was used for corneal wound closure. A high degree of with-the-rule astigmatism was evident in all patients two weeks postoperatively, but thereafter the character of the astigmatism produced by 8/0 virgin silk and 10/0 monofilament closure was quite different: in the 8/0 virgin silk group there was an early and pronounced shift in the axis of astigmatism to against-the-rule, whereas in the 10/0 monofilament group there was little further change in the astigmatism unless the sutures were removed. Wound compression and wound gape as factors responsible for these changes are discussed.     

白内障摘除、人工晶体植入术后慢性眼内炎

探讨白内障摘除,人工晶体植入术后慢性眼内炎的病因,临床特点及治疗效果,方法：４例白内障摘除、人工晶体植入术后慢性眼内炎分别接受了玻璃体切除、人工晶体取出等治疗,并作微生物学检查。结果：术３例保存有用视力,１例眼球萎缩;１例自结膜囊培养出丙酸杆菌,３例微生物培养均为阴性。     

Alcaligenes xylosoxidans endophthalmitis 8 months after cataract extraction

PURPOSE: To report a case of Alcaligenes xylosoxidans endophthalmitis and to increase awareness of its potential as an intraocular pathogen. METHODS: An 80-year-old woman in good general health developed A. xylosoxidans endophthalmitis 8 months after an uncomplicated cataract extraction performed at another institution. Eventually, vitrectomy with removal of the intraocular lens and capsule was performed because of recurrent disease after intravitreal antibiotic injections. RESULTS: Microbiologic examination of the vitreous biopsies and capsule disclosed A. xylosoxidans, a motile, gram-negative rod resistant to many antibiotics. CONCLUSION: A. xylosoxidans should be considered as a cause of low-grade endophthalmitis after cataract surgery.