title: Recurrent Enterococcus faecalis endophthalmitis after phacoemulsification.
abstract: 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.
authors.affiliation: The Eye Institute, Tan Tock Seng Hospital, Singapore, Republic of Singapore. stephen_teoh@ttsh.com.sg
authors.forename: Stephen C B
authors.initials: SC
authors.lastname: Teoh
authors.forename: Jong-Jian
authors.initials: JJ
authors.lastname: Lee
authors.forename: Caroline K L
authors.initials: CK
authors.lastname: Chee
authors.forename: Kah-Guan
authors.initials: KG
authors.lastname: Au Eong
mesh_terms: D000583:Amikacin / Q000627:therapeutic use; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D009877:Endophthalmitis / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D013293:Enterococcus faecalis / Q000302:isolation & purification*; D015818:Eye Infections, Bacterial / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D016908:Gram-Positive Bacterial Infections / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018918:Phacoemulsification; D011183:Postoperative Complications; D012008:Recurrence; D014640:Vancomycin / Q000627:therapeutic use; D014821:Vitrectomy
chemical_list: D014640:Vancomycin; D000583:Amikacin