Posters

A rare case of delayed-onset endophthalmitis after 9 years of routine cataract surgery

Poster Details

First Author: T. Balaji Prasad UNITED KINGDOM

Co Author(s):    D. Kumar   M. Rana                 

Abstract Details

Purpose:

To present a case of a patient who developed a delayed onset endophthalmitis after undergoing a routine uneventful cataract surgery more that 9 years ago and to highlight the clinical features and medical management strategic planning in giving a good outcome for such a condition.

Setting:

University Hospitals of Coventry & Warwickshire, Coventry, UK.

Methods:

72years female patient attended Eye casualty with 3 weeks’ soreness in left eye. She had Type 2 Diabetes, Hypertension and Hypercholesterolemia. Her left eye vision was reduced to 0.4 Logmar. Anterior segment showed mutton fat keratic precipitates, grade1 cells with circular pupil without posterior synechiae, posterior chamber intraocular lens with multiple linear posterior capsular opacification. Fundus showed clear vitreous with mild non proliferative diabetic retinopathy and no signs of clinically significant macular oedema. As inflammation was mainly in the anterior chamber with no signs of vitreal inflammation an anterior chamber aqueous tap was done.

Results:

Aqueous tap PCR was positive for Propionibacterium acnes. Multidisciplinary approach was followed and with guidance from the microbiology team, the patient was commenced on induction dose of oral Clarithromycin 500mg qid for 1 week, followed by maintenance dose of 500mg bd for 3 weeks and topical dexamethasone qid for 4 weeks. The mutton fat keratic precipitates and anterior chamber inflammation disappeared, the thick linear posterior capsular deposits remained unchanged. Vision improved to 0.2Logmar after 1 month. Patient denied further surgical intervention as she was quite pleased with the level of recovery and didn't want to risk any sight loss. The patient was followed up for a period of 6 months, where no recurrence of anterior segment inflammation was noted.

Conclusions:

This is a rare case of Propionibacterium related delayed onset endophthalmitis which presented with active inflammation after 9 years after uncomplicated cataract extraction with intraocular lens implant. These patients should be offered medical treatment first, with oral Clarithromycin, before subjecting them to complicated surgical procedure for intraocular lens explant with posterior capsulectomy. If there is a need for futher YAG laser posterior capsulotomy, they should be prophylactically treated with Clarithromycin to reduce the incidence of post laser endophthalmitis, as the sequestrated bacterium may be still present in these patients for long duration.

Financial Disclosure:

NONE