Bacterial subretinal abscess: a case report and review of the literature.
OBJECTIVE
To report a case of Klebsiella subretinal abscess with a successful visual outcome with treatment and to review the literature pertaining to focal intraocular infection in bacterial endophthalmitis.


METHODS
Clinical data including medical history, findings on physical examination, blood cultures, and an abdominal computed tomographic scan were collected in a 32-year-old man with Klebsiella sepsis, liver abscesses, and a focal subretinal abscess. Ocular data including visual acuity, fundus photographs, fluorescein angiography, and ultrasound were evaluated, as were results of culture and histopathologic studies.


RESULTS
Despite immediate intervention, including vitreous tap and intravitreal antibiotics, the eye deteriorated, with enlargement of the abscess. A pars plana vitrectomy was performed in which the subretinal abscess material was removed after an extensive retinectomy of the involved area in association with an endophotocoagulative barrier and intravitreal amikacin without gas or oil tamponade. Culture confirmed Klebsiella subretinal infection. A retinal detachment occurred 1 month postoperatively and was successfully repaired. Visual acuity was 20/30 and has remained stable for 14 months.


CONCLUSIONS
Klebsiella endophthalmitis with subretinal abscess formation is a rare but devastating ocular condition. In the present case, prompt intervention with extensive retinectomy, complete abscess excision, and intravitreal antibiotic therapy resulted in unprecedented visual recovery.
Retina Service of the Massachusetts Eye & Ear Infirmary and Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts 02114, USA.
E W
EW
Harris
D J
DJ
D'Amico
R
R
Bhisitkul
G P
GP
Priebe
R
R
Petersen
D000038:Abscess / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D000328:Adult; D000900:Anti-Bacterial Agents; D016470:Bacteremia / Q000175:diagnosis / Q000382:microbiology; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D009877:Endophthalmitis / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy; D015818:Eye Infections, Bacterial / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D005451:Fluorescein Angiography; D006801:Humans; D007709:Klebsiella / Q000302:isolation & purification*; D007710:Klebsiella Infections / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D017075:Laser Coagulation; D008100:Liver Abscess / Q000000981:diagnostic imaging / Q000382:microbiology; D008297:Male; D012164:Retinal Diseases / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D014057:Tomography, X-Ray Computed; D014792:Visual Acuity; D014821:Vitrectomy
D000900:Anti-Bacterial Agents