J Retin.  2022 Nov;7(2):133-137. 10.21561/jor.2022.7.2.133.

A Case of Postoperative Bacterial Endophthalmitis after Successful Treatment of Suspected Iatrogenic Fungal Endophthalmitis

• Kwon JM
• Han SY
• Bang JW
• Pak KY
• Kim HW

• KMID: 2552147
• DOI: http://doi.org/10.21561/jor.2022.7.2.133

Abstract

Purpose
To report a case of postoperative bacterial endophthalmitis that occurred after successful treatment of suspected iatrogenic fungal endophthalmitis associated with viscoelastics.
Case summary
A 60-year-old female was referred with decreased visual acuity 2 months after uneventful cataract surgery. Inflammatory cells in the anterior chamber and fluffy balls in the vitreous were observed. Clinically, postoperative fungal endophthalmitis was suspected. Postoperative fungal endophthalmitis was prevalent in Korea at that time, and the viscoelastic material used during surgery was judged to be unsuitable. Vitrectomy, intraocular lens removal, and intravitreal voriconazole injection were performed. With subsequent intravitreal injections and oral treatment, all signs of endophthalmitis disappeared. Three months later, the patient underwent scleral fixation of intraocular lens at another clinic and visited our emergency room with decreased vision in the right eye 2 days after the surgery. Her visual acuity was hand motion. Fundus was obscured due to corneal edema and anterior chamber inflammation. For suspected bacterial endophthalmitis, vitreous lavage, intravitreal silicone oil injection, and intravitreal antibiotics injection were performed, and the culture showed Staphylococcus epidermidis. Silicone oil was removed 2 months after the surgery, and the best-corrected visual acuity was maintained at 0.9 without recurrence of endophthalmitis.
Conclusions
Since patients who have suffered endophthalmitis are vulnerable to infection due to tissue damage caused by previous infection, special attention should be paid during additional procedures or surgeries.

Keyword

Endophthalmitis; Fungi; Staphylococcus epidermidis; Viscoelastics