J Korean Ophthalmol Soc.  2019 Jul;60(7):701-705. 10.3341/jkos.2019.60.7.701.

Chronic Recurrent Methicillin Resistant Staphylococcus Hemolyticus Endophthalmitis after Cataract Surgery

• Kim DS
• Lee MJ
• Seong MC
• Kang MH
• Cho HY
• Shin YU

• KMID: 2453023
• DOI: http://doi.org/10.3341/jkos.2019.60.7.701

Abstract

PURPOSE
To report a case of recurrent endophthalmitis due to methicillin resistant Staphylococcus hemolyticus after phacoemulsification and posterior chamber intraocular lens (IOL) implantation.
CASE SUMMARY
A 76-year-old female visited our outpatient clinic with decreased vision 40 days after uncomplicated cataract surgery in her right eye. At the visit, anterior chamber inflammation and cloudy fluid between the posterior capsule and IOL were observed. Uveitis due to residual cortex of lens or capsular block syndrome was suspected, so YAG laser capsulotomy and subconjunctival injection of dexamethasone were performed. Two days later, hypopyon and vitreous opacity were seen. The patient underwent an emergency vitrectomy and intravitreal antibiotic injection with suspicion of bacterial endophthalmitis. The culture was negative. Twenty days after the vitrectomy, anterior chamber inflammation and vitreous opacity developed. The recurrence of endophthalmitis was suspected due to infection by bacteria in the surrounding tissue of the IOL, so the patient underwent an IOL and lens capsule removal with intravitreal antibiotic injection. At this time, the culture revealed methicillin resistant staphylococcus hemolyticus. Systemic and topical vancomycin was then administered, resulting in decreased inflammation. Twenty days after the IOL removal, decreased vision, anterior chamber inflammation, and vitreous opacity developed. Endophthalmitis was decreased by intravitreal antibiotic injection and topical antibiotic treatment.
CONCLUSIONS
Methicillin resistant staphylococcus hemolyticus should be considered in the differential diagnosis of chronic recurrent endophthalmitis after cataract surgery.

Keyword

Endophthalmitis; Methicillin resistant Staphylococcus; Recurrent

MeSH Terms

Aged
Ambulatory Care Facilities
Anterior Chamber
Bacteria
Cataract*
Dexamethasone
Diagnosis, Differential
Emergencies
Endophthalmitis*
Female
Humans
Inflammation
Lasers, Solid-State
Lenses, Intraocular
Methicillin Resistance*
Methicillin*
Phacoemulsification
Recurrence
Staphylococcus*
Uveitis
Vancomycin
Vitrectomy
Dexamethasone
Methicillin
Vancomycin

Figure

• 

  Figure 1 Anterior segment photographs and fundus photographs at the initial presentation. (A) Anterior chamber inflammation and cloudy fluid between the posterior capsule and intraocular lens were seen. (B) Two days after YAG laser posterior capsulotomy, hypopyon developed. (C) The fundus photo after YAG laser posterior capsulotomy and subconjunctival injection of dexamethasone. Fundus photo was hazy due to vitritis. (D) Fundus photo after emergency vitrectomy, anterior chamber irrigation and intravitreal antibiotics injection. There were no lesions, scars, or pigmentary changes in the macula or periphery retina. Mild hazy view was observed because of residual inflammation.

• 

  Figure 2 Twenty days after the first vitrectomy, anterior segment photographs and fundus photographs. (A) Slit like hypopyon was observed. (B) Hazy view of the fundus was observed. (C) The fundus photographs - after intraocular lens removal and intravitreal antibiotics injection.

• 

  Figure 3 Follow up optical coherence tomography (OCT) and fluorescein angiography (FAG). (A) After the first vitrectomy, OCT of the patient showed normal retinal layers. (B, C) OCT of the patient before (B) and after (C) scleral fixation of intraocular lens (IOL). Epiretinal membrane and hyper-reflective dots were observed on the patient's retinal layers. (D) FAG of the patient before scleral fixation of IOL. Some leakage observed on the late phase of fluorescein angiography.

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