Endophthalmitis is a rare but severe form of ocular inflammation due to infection of the intraocular cavity that can lead to irreversible visual loss if not treated properly and timely. It can be classified as exogenous or endogenous based on the transmission route of the infectious source. Exogenous endophthalmitis occurs when infecting organisms gain entry into the eye via direct inoculation, while endogenous endophthalmitis occurs when infectious agents hematogenously spread into the eye from a distant focus of infection. The diagnosis of endophthalmitis depends mostly on the clinical findings on ophthalmological examination. Delayed diagnosis of endogenous endophthalmitis can lead to not only visual loss, but also increased risk of mortality. Since ocular and systemic symptoms of endophthalmitis are usually non-specific, early diagnosis relies on the alertness of clinicians. Early diagnosis and proper treatment are keys to saving the eye. Following advances in vitreoretinal pharmacotherapy and surgical technology, early surgical intervention is the current trend in the management of endophthalmitis.
Delayed Diagnosis ; Diagnosis ; Drug Therapy ; Early Diagnosis ; Endophthalmitis* ; Inflammation ; Mortality

Endophthalmitis ; diagnosis ; drug therapy ; etiology ; Eye Infections, Fungal ; diagnosis ; drug therapy ; etiology ; Humans ; Infant, Newborn ; Infant, Premature ; Male

To report a case of bilateral endophthalmitis as the initial presentation of bacterial meningitis in a young, immunocompetent Korean patient. A 35-year-old female with a one day history of bilateral swollen eyes, visual disturbance, headache, petechial skin rash, and nausea visited our clinic. She was diagnosed as having endogenous endophthalmitis associated with bacterial meningitis. Intravenous broad spectrum antibiotic therapy was initiated with cefotaxime 3 g and ubacillin 3 g, four times daily. Intravitreal antibiotic (vancomycin 1 mg/0.1 mL and ceftazidime 2 mg/0.1 mL) injections were performed in both eyes. Two weeks post presentation, the best corrected visual acuity in both eyes improved to 0.7, and inflammation of the anterior chamber and vitreous cavity was decreased. We recommend that when endogenous endophthalmitis is suspected along with meningitis, or if it is known to be present, intravitreal and intravenous antibiotics should be promptly administered to preserve vision.
Adult ; Anti-Bacterial Agents/therapeutic use ; Diagnosis, Differential ; Endophthalmitis/diagnosis/drug therapy/*etiology ; Eye Infections, Bacterial/diagnosis/drug therapy/*etiology ; Female ; Follow-Up Studies ; Humans ; Meningitis, Bacterial/*complications/diagnosis/drug therapy ; Ophthalmoscopy

Although there have been a few reported cases of Enterococcal endophthalmitis, this is an unusual case of endophthalmitis complicated with corneal ulcer caused by Enterococcus faecalis. A 67-year-old male patient with diabetes mellitus underwent secondary intraocular lens implantation. Post-operative recovery was uneventful until a wound rupture was noted 3 weeks after the operation. On day 12 after the repair of the wound, endophthalmitis accompanied by wound necrosis and a fullthickness corneal ulcer was detected. His vision was light perception, and Enterococcus faecalis was identified by culture in samples of conjunctival sac, anterior chamber and vitreous humor. After 3 rounds of intravitreal antibiotics injection, the vitreous opacity disappeared on ultrasonographic finding but corneal opacity and corneal neovascularization still remained.
Aged ; Anti-Bacterial Agents/administration & dosage ; Corneal Ulcer/diagnosis/drug therapy/*microbiology ; Endophthalmitis/diagnosis/drug therapy/*microbiology ; Enterococcus faecalis/drug effects/*isolation & purification ; *Eye Infections, Bacterial/diagnosis/drug therapy/microbiology ; Gram-Positive Bacterial Infections/diagnosis/drug therapy/*microbiology ; Humans ; Lens Implantation, Intraocular ; Male ; Microbial Sensitivity Tests ; Surgical Wound Infection/diagnosis/drug therapy/*microbiology ; Treatment Outcome

A 75-year-old female was transferred to our clinic three days after uneventful phacoemulsification with intraocular lens (IOL) implantation in the right eye that had been carried out at a local clinic. Under the diagnosis of postoperative endophthalmitis, the patient underwent pars plans vitrectomy, IOL explantation, silicone oil tamponade, and intravitreal antibiotic injection. Even after the procedure, the patient's condition was further aggravated, and extended-spectrum beta-lactamase-producing Escherichia coli were identified on bacterial identification test. Although meropenem was applied locally and systemically, the patient had no-light perception visual acuity.
Aged ; Anti-Bacterial Agents/therapeutic use ; Endophthalmitis/drug therapy/*microbiology ; Escherichia coli/*isolation & purification ; Female ; Humans ; Phacoemulsification ; Postoperative Complications/diagnosis/*microbiology ; Visual Acuity ; beta-Lactamases

Klebsiella pneumoniae liver abscess has a tendency to spread to distant sites early in the course of disease and to involve multiple organs synchronously. A 59-year-old male was admitted because of liver abscess accompanied by fever and abdominal pain. The patient underwent percutaneous catheter drainage and received intravenous antibiotics. Symptom relief was achieved after the treatment as well as marked reduction in the size of the abscess. Despite proper treatment of the liver abscess, however, patient developed multiple metastatic infections in a non-concurrent manner: left and right endophthalmitis, psoas abscess, and infectious spondylitis at 5, 23, 30 and 65 days after initial manifestations of liver abscess, respectively. Each infectious episode followed one another after resolution of the former one. For each episode of metastatic infections, the patient promptly underwent treatment with systemic and local antibiotics, interventional abscess drainage, and surgical treatments as needed. The patient fully recovered without sequelae after the use of intravenous antibiotics for an extended period of time. Herein, we report a case of K. pneumoniae liver abscess complicated with delayed-onset multiple metastatic infections.
Anti-Bacterial Agents/therapeutic use ; Ceftriaxone/therapeutic use ; Drainage ; Endophthalmitis/diagnosis/drug therapy ; Humans ; Injections, Intravenous ; Klebsiella Infections/complications/*diagnosis/drug therapy ; Klebsiella pneumoniae/isolation & purification ; Liver Abscess/*diagnosis/etiology ; Male ; Middle Aged ; Psoas Abscess/diagnosis/etiology ; Spondylitis/diagnosis/drug therapy ; Tomography, X-Ray Computed

PURPOSE: To report a case of an acute onset of delayed postoperative endophthalmitis that was caused by Sphingomonas paucimobilis. METHODS: This case demonstrates an acute onset of delayed postoperative endophthalmitis at 3 months after uneventful cataract extraction and posterior chamber intraocular lens implantation. We performed vitrectomy, intraocular lens and capsular bag removal, and intravitreal antibiotics injection. On the smear stains from the aspirated vitreous humor, gram-negative bacilli were detected and S. paucimobilis was found in culture. RESULTS: At three months after vitrectomy, the best corrected visual acuity was 20/300. Fundus examination showed mild pale color of optic disc and macular degeneration. CONCLUSIONS: Vitrectomy with intravitreal ceftazidime injection had contributed to the favorable result in case of an acute onset of delayed postoperatire endophthalmitis caused by S. paucimobilis.
Anti-Bacterial Agents/therapeutic use ; Ceftazidime/therapeutic use ; Combined Modality Therapy ; Endophthalmitis/diagnosis/drug therapy/*microbiology ; Eye Infections, Bacterial/diagnosis/drug therapy/*microbiology ; Gram-Negative Bacterial Infections/diagnosis/drug therapy/*microbiology ; Humans ; Lens Implantation, Intraocular ; Male ; Middle Aged ; *Phacoemulsification ; *Postoperative Complications ; Sphingomonas/*isolation & purification ; Visual Acuity ; Vitrectomy ; Vitreous Body/microbiology

PURPOSE: To report a case of an acute onset of delayed postoperative endophthalmitis that was caused by Sphingomonas paucimobilis. METHODS: This case demonstrates an acute onset of delayed postoperative endophthalmitis at 3 months after uneventful cataract extraction and posterior chamber intraocular lens implantation. We performed vitrectomy, intraocular lens and capsular bag removal, and intravitreal antibiotics injection. On the smear stains from the aspirated vitreous humor, gram-negative bacilli were detected and S. paucimobilis was found in culture. RESULTS: At three months after vitrectomy, the best corrected visual acuity was 20/300. Fundus examination showed mild pale color of optic disc and macular degeneration. CONCLUSIONS: Vitrectomy with intravitreal ceftazidime injection had contributed to the favorable result in case of an acute onset of delayed postoperatire endophthalmitis caused by S. paucimobilis.
Anti-Bacterial Agents/therapeutic use ; Ceftazidime/therapeutic use ; Combined Modality Therapy ; Endophthalmitis/diagnosis/drug therapy/*microbiology ; Eye Infections, Bacterial/diagnosis/drug therapy/*microbiology ; Gram-Negative Bacterial Infections/diagnosis/drug therapy/*microbiology ; Humans ; Lens Implantation, Intraocular ; Male ; Middle Aged ; *Phacoemulsification ; *Postoperative Complications ; Sphingomonas/*isolation & purification ; Visual Acuity ; Vitrectomy ; Vitreous Body/microbiology

PURPOSE: To report a case of endogenous endophthalmitis due to Aeromonas hydrophila in a patient with distal common bile duct carcinoma and biliary sepsis. METHODS: A 72-year-old woman with distal common bile duct carcinoma, obstructive jaundice, diabetes mellitus, and hypertension had a 1-day history of blurred vision, redness, and eye discharges in the right eye. An ophthalmic examination showed no light perception vision, increased intraocular pressure, severe corneal edema, severe anterior chamber reaction, exudative membranes on the anterior lens surface, and severe vitreal reaction. There was no ocular history of trauma, infection, or surgery in either eye. RESULTS: Under the impression of endogenous bacterial endophthalmitis, immediate intraocular cultures and intravitreal antibiotic injections were performed, but the anterior chamber reaction, and the ultrasonogram findings were deteriorated. Evisceration was undertakened because of extrusion of the intraocular contents, and Aeromonas hydrophila was isolated by intraocular culture. CONCLUSIONS: Endogenous endophthalmitis due to Aeromonas hydrophila is rare, but has a rapid clinical course and a poor prognosis, despite of prompt diagnosis and management.
Vitreous Body ; Ultrasonography ; Treatment Failure ; Tomography, X-Ray Computed ; Injections ; *Immunocompromised Host ; Humans ; *Gram-Negative Bacterial Infections/drug therapy ; Female ; Eye Evisceration ; Endophthalmitis/diagnosis/*microbiology/pathology ; Anti-Bacterial Agents/administration & dosage/therapeutic use ; Aged ; *Aeromonas hydrophila

A 58-year-old man admitted to our opthalmology department with the complaint of branch retinal vein occlusion. He was treated with intravitreal Ozurdex in the right eye. Two days after the injection, the patient presented with ocular pain and the visual acuity was hand movement. A diagnosis of endophthalmitis was made. We performed emergent pars plana vitrectomy (PPV) and the implant was removed from the vitreous cavity using a retinal forceps. A combination of vancomycin 1.0 mg and amikacin 0.4 mg was injected intravitreally. However, because of the blurring in the vitreus one week after the procedure, phacoemulsification and a repeat PPV was performed. Five days after the last procedure the signs and symptoms of endophthalmitis were resolved. Our case demonstrated that endophthalmitis could develop after intravitreal implantation of Ozurdex. Surgical removal of the implant and immediate vitrectomy seems to be a useful treatment option in these cases.
Device Removal/methods ; Dexamethasone/administration & dosage/*adverse effects ; Diagnosis, Differential ; Drug Implants/*adverse effects ; Endophthalmitis/diagnosis/*etiology/surgery ; Eye Infections, Bacterial/diagnosis/*etiology/surgery ; Glucocorticoids/administration & dosage/adverse effects ; Humans ; Intravitreal Injections/adverse effects ; Male ; Middle Aged ; Retinal Vein Occlusion/diagnosis/*drug therapy ; Vitrectomy