Case Reports

Endophthalmitis after non-complicated cataract surgery by Serratia marcescens

Case Report Details

First Author: S.Montolio Marzo SPAIN

Co Author(s):    S. Montolío-Marzo   M. Pérez-López   J. Piá-Ludeña   M. Roig-Revert   J. Mataix-Boronat   C. Peris-Martínez     

Abstract Details

Purpose:

Describe fatal complication after non-complicated cataract surgery secondary to a rare microorganism

Setting:

FISABIO Oftalmología Médica (Valencia, Spain) and Hospital Universitari I Politécnic (Valencia, Spain)

Report of Case:

75 years old patient underwent non-complicated cataract surgery under periocular anesthesia. Prophylactic povidone iodine was applied periocularly and topically inside the eye. Intracameral cefuroxime was used by the end of the surgery. One day postop intraocular lens was correctly placed, there was no leaking through incisions and no other findings were reported. Usual postop treatment was prescribed with ofloxacin three times a day, dexamethasone five times a day and diclofenac three times a day. The patient attended the emergency room 36 hours after surgery with severe ocular pain and decreased vision to hand movement. Severe hyperemia, incipient corneal melting, severe anterior chamber inflammatory reaction (minimal hipopyon), and absent red reflex. Intravitreal and topical vancomycin and ceftacydime were applied. After 72 hours the patient showed preseptal cellulitis and worsening of intraocular involvement. Pars plana vitrectomy couldn’t be performed cause the sclera was melty. Antibiotic theraphy was confirmed to be effective after antibiogram and diagnosis of the microorganism by microbiology department. Intravenous linezolid was added to the therapeutics. After 5 days computerized tomography showed orbital involvement and high risk of cavernous sinus septic thrombosis and thus the eye was eviscerated. After surgery the infection could be controlled with no risk for life.

Conclusion/Take Home Message:

Serratia marcenses is a very rare pathogen and has been mostly related to endogenous endophthalmitis. As showed in this case it can be secondary to cataract surgery (despite extremely rare) and prognosis is fatal despite therapeutic effort.

Financial Disclosure:

None