J Korean Ophthalmol Soc.  2015 Apr;56(4):632-637. 10.3341/jkos.2015.56.4.632.

Two Cases of Recurrent Enterococcus Faecalis Endophthalmitis after Cataract Surgery

• Ahn MW
• Shin MK
• Park SW
• Lee JE

• KMID: 2215718
• DOI: http://doi.org/10.3341/jkos.2015.56.4.632

Abstract

PURPOSE
To report 2 cases of recurrent Enterococcus faecalis (E. faecalis) endophthalmitis after uneventful phacoemulsification and posterior chamber intraocular lens (IOL) implantation.
CASE SUMMARY
Case 1: A healthy, 75-year-old female presented with a sudden visual loss and ocular pain 2 days after phacoemulsification and IOL implantation. After successful treatment with intravitreal antibiotics injection, the infection was apparently cleared. At 1 month after the initial presentation, recurrent endophthalmitis occurred and was resolved with vitrectomy, silicon oil tamponade, and intravitreal antibiotics injection. Two months after vitrectomy, the silicone oil was removed and the patient's final visual acuity improved to 20/400 5 months later. Case 2: A healthy, 74-year-old female presented with a sudden visual loss 2 days after phacoemulsification and IOL implantation. After successful treatment with intravitreal antibiotics injection, the infection was apparently cleared. One month later, recurrent endophthalmitis occurred and was resolved with vitrectomy, posterior capsulotomy, and intravitreal antibiotics injection. Forty days later, the patient had a similar relapse. The infection resolved with IOL explantation, silicon oil tamponade, and repeated intravitreal antibiotics injections. E. faecalis was identified at the first and recurrent episode. Vancomycin and ceftazidime were used for each intravitreal administration. Silicone oil removal and IOL scleral fixation were performed and the patient's final visual acuity was 20/40 5 months later.
CONCLUSIONS
Close monitoring for recurrences is recommended in endophthalmitis due to E. faecalis after phacoemulsification even after a successful initial treatment.

Keyword

Endophthalmitis; Enterococcus faecalis; Recurrent endophthalmitis

MeSH Terms

Aged
Anti-Bacterial Agents
Cataract*
Ceftazidime
Endophthalmitis*
Enterococcus faecalis*
Female
Humans
Lenses, Intraocular
Phacoemulsification
Posterior Capsulotomy
Recurrence
Silicone Oils
Vancomycin
Visual Acuity
Vitrectomy
Anti-Bacterial Agents
Ceftazidime
Silicone Oils
Vancomycin

Figure

• 

  Figure 1. Recurrent endopthalmitis at 1 month after intravitreal antibiotics injection. Exudative membrane, hypopyon, and ocular injection were found.

• 

  Figure 2. At five months after recurrent endophthalmitis, there was no inflammation or infection signs on fundus photo (A) and spectral domain optical coherent tomography (SD-OCT) (B). SD-OCT images showed macular thinning.

• 

  Figure 3. First episode of endopthalmitis. Two days after cataract surgery, exudative inflammation with hypopyon were noticed.

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  Figure 4. At 1 month after vitrectomy, posterior capsulotomy, and intravitreal antibiotics injection, there was no inflammation or infection signs on fundus photo (A) and spectral domain optical coherent tomography (B).

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  Figuer 5. Third episode of endophthalmitis. At forty days after second episode, sudden visual loss, eyeball pain, and hypopyon recurred.

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  Figure 6. At 5 days after silicone oil removal and intraocular lens scleral fixation, well located intraocular lens were presented (B). There was no infection sign on fundus photo (A) and spectral domain optical coherent tomography (C).

Reference

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