Recurrent endophthalmitis after cataract surgery with a scleral-tunnel incision.
OBJECTIVE
To present a case of recurrent postoperative endophthalmitis with a scleral-tunnel abscess and adjacent microbial keratitis.


METHODS
A 76-year-old woman with microbial keratitis and recurrent endophthalmitis after cataract surgery was referred to a tertiary care center for further management. The medical chart of the patient was reviewed.


RESULTS
The patient was seen on the eighth postoperative day with endophthalmitis that responded to medical treatment. Initial vitreous cultures were negative. The endophthalmitis recurred after the medical treatment was discontinued. She subsequently developed microbial keratitis at 1 o'clock adjacent to the limbus. Cultures from the site of corneal abscess and vitreous grew coagulase-negative Staphylococcus. Gonioscopy revealed the presence of a scleral abscess, which responded to subconjunctival injection of vancomycin and an intense and prolonged course of topical antibiotics.


CONCLUSIONS
A scleral abscess should be suspected in a patient with endophthalmitis or microbial keratitis or both after a scleral-tunnel incision for cataract surgery.
Ayyala
R S
RS
University of South Florida Eye Institute, Tampa 33612-4799, USA.
Stevens
S X
SX
Grizzard
W S
WS
Fouraker
B D
BD
D000287:Administration, Topical; D000368:Aged; D002387:Cataract Extraction / Q000009:adverse effects*; D002437:Cefazolin / Q000627:therapeutic use; D003315:Cornea / Q000382:microbiology; D004359:Drug Therapy, Combination; D009877:Endophthalmitis / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D015818:Eye Infections, Bacterial / Q000188:drug therapy / Q000382:microbiology* / Q000473:pathology; D005260:Female; D006801:Humans; D007267:Injections; D007634:Keratitis / Q000188:drug therapy / Q000382:microbiology* / Q000473:pathology; D012008:Recurrence; D012590:Sclera / Q000601:surgery*; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000382:microbiology* / Q000473:pathology; D013210:Staphylococcus / Q000302:isolation & purification*; D013536:Suture Techniques; D014640:Vancomycin / Q000627:therapeutic use; D014822:Vitreous Body / Q000382:microbiology
D014640:Vancomycin; D002437:Cefazolin