Two Cases of Recurrent Enterococcus Faecalis Endophthalmitis after Cataract Surgery

Min Won Ahn; Min Kyu Shin; Sung Who Park; Ji Eun Lee

doi:10.7469/JKOS.2015.56.04.632

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Ahn, Shin, Park, and Lee: Two Cases of Recurrent Enterococcus Faecalis Endophthalmitis after Cataract Surgery

Original Article

J Korean Ophthalmol Soc 2015;56(4):632-637.

Published online: 7 September 2015

DOI: https://doi.org/10.7469/JKOS.2015.56.04.632

Two Cases of Recurrent Enterococcus Faecalis Endophthalmitis after Cataract Surgery

Min Won Ahn, MD¹, Min Kyu Shin, MD¹, Sung Who Park, MD¹, Ji Eun Lee, MD, PhD^1,²

¹Department of Ophthalmology, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea

²Department of Ophthalmology, Pusan National University School of Medicine, Busan, Korea

￭ Address reprint requests to Sung Who Park, MD Department of Ophthalmology, Pusan National University Hospital, #179 Gudeok-ro, Seo-gu, Busan 602-739, Korea Tel: 82-51-240-7326, Fax: 82-51-242-7341 E-mail: oph97@naver.com

Received 31 October 20143 January 2015 Accepted 7 March 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

초록

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 ex-plantation, 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.

Keywords: Endophthalmitis, Enterococcus faecalis, Recurrent endophthalmitis

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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.

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).

Figuer 5.

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

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).

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