Recurrent Enterococcus faecalis endophthalmitis after phacoemulsification

J Cataract Refract Surg. 2005 Mar;31(3):622-6. doi: 10.1016/j.jcrs.2004.06.047.

Abstract

We present the first reported case of late recurrence of postoperative Enterococcus faecalis endophthalmitis after cataract surgery in a 45-year-old diabetic man. Culture-positive E faecalis endophthalmitis was diagnosed 2 days after uneventful phacoemulsification. Early vitrectomy with intravitreal and subconjunctival vancomycin and amikacin and topical vancomycin resulted in apparently complete clinical resolution after 4 months and a best corrected visual acuity of 20/25. Recurrent endophthalmitis with hypopyon occurred 7 months postoperatively and resolved with intravitreal vancomycin and topical prednisolone acetate 1%. However, the patient had a similar relapse at 9 months that resulted in deterioration of visual acuity to no light perception despite a repeat vitrectomy, intraocular lens explantation, capsular bag removal, and intravitreal antibiotics. The late recurrences could have been the result of persistent sequestration of the organism in the capsular bag.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Amikacin / therapeutic use
  • Drug Therapy, Combination / therapeutic use
  • Endophthalmitis / diagnosis
  • Endophthalmitis / drug therapy
  • Endophthalmitis / microbiology*
  • Enterococcus faecalis / isolation & purification*
  • Eye Infections, Bacterial / diagnosis
  • Eye Infections, Bacterial / drug therapy
  • Eye Infections, Bacterial / microbiology*
  • Gram-Positive Bacterial Infections / diagnosis
  • Gram-Positive Bacterial Infections / drug therapy
  • Gram-Positive Bacterial Infections / microbiology*
  • Humans
  • Male
  • Middle Aged
  • Phacoemulsification*
  • Postoperative Complications*
  • Recurrence
  • Vancomycin / therapeutic use
  • Vitrectomy

Substances

  • Vancomycin
  • Amikacin