title: Recurrent enterococcal endophthalmitis seeded by an intraocular lens biofilm.
abstract: A case of endophthalmitis following uneventful phacoemulsification and posterior chamber intraocular lens (IOL) implantation in a 77-year-old diabetic man was culture-positive for Enterococcus faecalis. After successful treatment with intravitreal, topical, and systemic antibiotic agents, the infection seemed to clear and the patient achieved a corrected visual acuity of 20/25. Four months after the initial presentation, the patient again developed signs and symptoms of endophthalmitis, with regrowth of E faecalis. The antibiotic therapy was repeated. One month later, the IOL was removed surgically and found to harbor a biofilm of the strain demonstrated by DNA analysis. The microbiologic and DNA analyses support that a biofilm on an IOL could be a vector for a cause of recurrent endophthalmitis. Intraocular lens exchange in cases of postoperative endophthalmitis caused by E faecalis may be considered to decrease the risk for recurrent infection.
authors.affiliation: Charles T. Campbell Ophthalmic Microbiology Laboratory, UPMC Eye Center, Ophthalmology and Visual Sciences Research Center, The Eye and Ear Institute, Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
authors.forename: Kimberly V
authors.initials: KV
authors.lastname: Miller
authors.forename: Kari M
authors.initials: KM
authors.lastname: Eisley
authors.forename: Robert M Q
authors.initials: RM
authors.lastname: Shanks
authors.forename: Roni M
authors.initials: RM
authors.lastname: Lahr
authors.forename: Kira L
authors.initials: KL
authors.lastname: Lathrop
authors.forename: Regis P
authors.initials: RP
authors.lastname: Kowalski
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Noecker
mesh_terms: D000368:Aged; D018441:Biofilms; D009877:Endophthalmitis / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D013293:Enterococcus faecalis / Q000302:isolation & purification / Q000502:physiology*; 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; D019654:Lens Implantation, Intraocular; D007910:Lenses, Intraocular / Q000382:microbiology*; D008297:Male; D018918:Phacoemulsification; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D012008:Recurrence