Enterococcal endophthalmitis following cataract extraction, treated with ampicillin intravitreally

Postcataract endophthalmitis caused by Enterococcus faecalis

PURPOSE

To investigate the management strategies, susceptibility patterns, and visual outcomes of postcataract Enterococcus faecalis endophthalmitis.

METHODS

Retrospective chart review study of 26 eyes of 26 patients with culture-proven E. faecalis endophthalmitis.

RESULTS

In initial treatments, pars plana vitrectomy with intravitreal antibiotics in 15 eyes (58%). Resistance patterns among the isolates were the following: vancomycin in 0 of 26 eyes (0%), ampicillin in 0 of 26 eyes (0%), teicoplanin in 0 of 18 eyes (0%), and high-level gentamicin (minimum inhibitory concentration > 500 mg/L) in 8 of 12 eyes (67%). Presenting visual acuity ranged from counting fingers to no light perception. Final visual acuity was better than 5/200 in 4 of 26 eyes (15%), 5/200 to hand motions in 4 of 26 eyes (15%), and light perception to no light perception in 18 of 26 eyes (69%).

CONCLUSIONS

Although all E. faecalis isolates were susceptible to vancomycin, endophthalmitis caused by E. faecalis was usually associated with poor visual prognosis.

Recurrent Enterococcus faecalis endophthalmitis after phacoemulsification

We present the first reported case of late recurrence of postoperative Enterococcus faecalis endophthalmitis after cataract surgery in a 45-year-old diabetic man. Culture-positive E faecalis endophthalmitis was diagnosed 2 days after uneventful phacoemulsification. Early vitrectomy with intravitreal and subconjunctival vancomycin and amikacin and topical vancomycin resulted in apparently complete clinical resolution after 4 months and a best corrected visual acuity of 20/25. Recurrent endophthalmitis with hypopyon occurred 7 months postoperatively and resolved with intravitreal vancomycin and topical prednisolone acetate 1%. However, the patient had a similar relapse at 9 months that resulted in deterioration of visual acuity to no light perception despite a repeat vitrectomy, intraocular lens explantation, capsular bag removal, and intravitreal antibiotics. The late recurrences could have been the result of persistent sequestration of the organism in the capsular bag.

A Case of Enterococcus Faecalis Endophthalmitis with Corneal Ulcer

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 full-thickness 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.