Propionibacterium-associated endophthalmitis after extracapsular cataract extraction. Review of reported cases.
Sixteen cases of previously reported culture-proven Propionibacterium-associated endophthalmitis after extracapsular cataract extraction (ECCE) are reviewed. The inflammation was observed 2 to 10 months after surgery and occurred after laser posterior capsulotomy in four cases. Clinically, it appeared as a chronic iridocyclitis characterized by granulomatous-appearing keratic precipitates (5 cases), hypopyon (10 cases), and a white plaque on the posterior capsule or intraocular lens (IOL) implant (8 cases). Response to corticosteroid treatment was transient. Surgical intervention was required between 1 and 16 months after the inflammation began and included removal of the IOL and capsular bag via the limbus in 7 cases and pars plana vitrectomy in 11. Intravitreal antibiotics were administered in 12 cases. Postoperative visual acuity ranged from 20/20 to count fingers, with 11 of 16 patients recovering visual acuity of 20/40 or better. Propionibacterium-associated endophthalmitis should be suspected if chronic indolent intraocular inflammation develops after ECCE. Intraocular specimens should be obtained and submitted for aerobic and anaerobic culture and cytologic/histopathologic studies. Based on the clinical courses of these patients, recommendations for management are discussed.
Department of Ophthalmology, Cleveland Clinic Foundation, OH 44106.
D M
DM
Meisler
S
S
Mandelbaum
D001424:Bacterial Infections; D002387:Cataract Extraction / Q000379:methods; D009877:Endophthalmitis / Q000209:etiology* / Q000601:surgery; D005123:Eye / Q000382:microbiology / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007910:Lenses, Intraocular; D008297:Male; D011183:Postoperative Complications; D011184:Postoperative Period; D011424:Propionibacterium / Q000302:isolation & purification; D014792:Visual Acuity; D014821:Vitrectomy