title: Delayed-Onset Post-Keratoplasty Endophthalmitis Caused by Vancomycin-Resistant Enterococcus faecium.
abstract: BACKGROUND
  Vancomycin-resistant Enterococcus (VRE) endophthalmitis after penetrating keratoplasty (PKP) is very rare, the management is a challenge due to both the pattern of antibiotic resistance and the aggressive nature of the infectious process. We report the first delayed-onset case of VRE endophthalmitis after PKP.
  
  
  METHODS
  Case report of a 51-year-old female with a 7-week history of PKP who arrived at the emergency room with signs and symptoms of endophthalmitis. Initial visual acuity was light perception, and a posterior pole exam was not possible due to the intense vitreous reaction. Mode B ultrasound was used to assess the posterior pole. The patient underwent pars plana vitrectomy and received intravitreous antibiotics.
  
  
  RESULTS
  Vitreous stains and cultures were positive for Enterococcus faecium resistant to vancomycin. Donor rim cultures and viral PCR were negative. Treatment was carried out by repeated intravitreal antibiotics and systemic linezolid. Clinical improvement was seen after the second dose of intravitreous antibiotics and systemic linezolid, but visual acuity remained at light perception consistent with the ischemic changes observed in the posterior pole.
  
  
  CONCLUSIONS
  VRE endophthalmitis might be associated with positive donor rim cultures. Prompt use of systemic linezolid in addition to intravitreous antibiotics is recommendable, but even with prompt treatment, visual prognosis is guarded.
authors.affiliation: Department of Cornea and Refractive Surgery, Instituto de Oftalmologia 'Conde de Valenciana', Mexico City, Mexico.
authors.forename: Julio C
authors.initials: JC
authors.lastname: Hernandez-Camarena
authors.forename: Victor M
authors.initials: VM
authors.lastname: Bautista-de Lucio
authors.forename: Alejandro
authors.initials: A
authors.lastname: Navas
authors.forename: Arturo
authors.initials: A
authors.lastname: Ramirez-Miranda
authors.forename: Enrique O
authors.initials: EO
authors.lastname: Graue-Hernandez